A study showed that rates of acute graft vs host disease (aGVHD) appeared associated with types of antibiotics used and timeframes of antibiotic exposure soon after allogeneic hematopoietic stem cell transplantation (HCT). Study results were published in JAMA Network Open.

“The findings of this cohort study suggest that several antibiotics commonly used to treat neutropenic fever and infections after HCT were associated with increased rates of aGVHD,” the study investigators wrote in their report.

The study was a single-center cohort analysis including adult patients who had undergone an initial T-cell–replete allogeneic HCT and had 6 or more months of follow-up. Patients in this study received antibiotics orally or intravenously during the period 7 days before transplant to 30 days after transplant.

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The study investigators evaluated outcomes in conjunction with types of antibiotics used and exposure times. The primary study outcome was aGVHD of grades 2 to 4, with a secondary outcome of aGVHD of grades 3 or 4. Risks of outcomes were estimated using 3 different types of statistical models, and they were calculated for 5 intervals of time of approximately 1 week each.

There were 2023 patients included in the analysis and they had a median age of 55 years (range, 18-78). Several types of antibiotics were commonly used in this population after allogeneic HCT. By post-HCT day 180, 72% of patients had developed aGVHD of grades 2 to 4, while 15% of patients had experienced aGVHD of grades 3 or 4.

In the first 4 weeks after allogeneic HCT, multiple associations with a risk of aGVHD were seen with different antibiotic classes. The risk during weeks 1 and 2 was highest with exposure to carbapenem antibiotics, with a minimum hazard ratio (HR) of 2.75 (95% CI, 1.77-4.28) calculated across the models.

The use of penicillin with a beta-lactamase inhibitor during week 1 after allogeneic HCT was associated with a minimum HR across models of 6.55 (95% CI, 2.35-18.20) for aGVHD risk. Several other antibiotic classes were also associated with increased aGVHD rates during particular periods of exposure.

“If our results are replicated in independent cohorts, antibiotic-associated risk of aGVHD could become a consideration in antibiotic stewardship programs,” the study investigators concluded in their report.

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of disclosures.


Rashidi A, Gao F, Fredricks DN, et al. Analysis of antibiotic exposure and development of acute graft-vs-host disease following allogeneic hematopoietic cell transplantation. JAMA Netw Open. 2023;6(6):e2317188. doi:10.1001/jamanetworkopen.2023.17188