Patterns of graft-versus-host disease (GVHD) in patients who received antibiotics prior to undergoing allogeneic hematopoietic stem cell transplantation (HSCT) were examined in a retrospective analysis, which revealed a possible link between GVHD and pretransplant glycopeptide antibiotic therapy. Results of the analysis were recently published in the journal Hematology.
The study investigators noted that fecal microbial population may influence GVHD in patients who receive allogeneic HSCT and also that patients with hematologic malignancies are often treated for febrile neutropenia with antibiotics before allogeneic HSCT. The researchers undertook this analysis to examine any relationship between pretransplant antibiotic use and GVHD.
The analysis was conducted using data from patients with hematologic malignancies who received allogeneic HSCT at Chungnam National University Hospital in Daejeon, South Korea. Pretransplant antibiotic use was characterized by receipt of antibiotic therapy prior to conditioning chemotherapy.
A total of 131 patients were evaluated, with more than half (58%) having acute myeloid leukemia. Acute lymphoblastic leukemia, myelodysplastic syndrome, and chronic myeloid leukemia were also represented. GVHD prophylaxis had been given to all patients, with each receiving methotrexate in combination with either cyclosporine or tacrolimus and with or without antithymocyte globulin.
Pretransplant antibiotic therapy for febrile neutropenia or infection consisted of cefepime in 87.0% of the total patients, piperacillin/tazobactam in 66.4%, glycopeptide in 53.4%, and carbapenem in 38.9%.
Glycopeptide use prior to transplant showed a possible link to extensive chronic GVHD, occurring at a 5-year cumulative incidence of 51.1% in patients who received it, compared with 28.1% of those who did not (P =.026). Chronic GVHD of the lung also occurred more with glycopeptide use (34.8% at 5 years) than without it (15.8%; P =.028). Glycopeptide use was not linked to statistically significant impacts on overall survival, relapse-free survival, or GVHD-free survival.
Carbapenem and glycopeptide use showed nonsignificant trends of higher incidence of grade 3 to 4 acute GVHD. With chronic GVHD, severity was not linked to pretransplant use of any of the examined antibiotic agents.
The study investigators concluded that pretransplant glycopeptide treatment may be associated with extensive chronic GVHD and that lungs appeared especially susceptible. They indicated that in patients undergoing allogeneic HSCT who receive pretransplant glycopeptide, monitoring for extensive chronic GVHD is warranted.
Lee MW, Yeon SH, Heo BY, et al. Impact of pre-transplant use of antibiotics on the graft-versus-host disease in adult patients with hematological malignancies. Hematology. 2021;26(1):96-102. doi:10.1080/16078454.2021.1872957