Early infections in adults undergoing matched related and matched unrelated/mismatched donor stem cell transplantation: a comparison of incidence

Bone Marrow Transplant. 2002 Sep;30(5):303-9. doi: 10.1038/sj.bmt.1703643.

Abstract

We compared the incidence of early infectious complications between matched related (MR) and matched unrelated/mismatched (MU/MM) allogeneic stem cell transplant (allo-SCT) recipients in a single centre over a 6-year period in 214 consecutive adult patients. Early infections were defined as occurring from hospital admission for SCT until discharge. One hundred and fifty-nine patients received an allograft from MR donors and 55 patients received MU/MM allo-SCT. One hundred and eight of 214 patients had 147 episodes of fever. Ninety-three episodes (63%) were due to clinically or microbiologically documented infections and 54 episodes (37%) to fever not related to infection. Patients undergoing MU/MM transplantation tended to have more documented infections compared to recipients of MR allo-SCT (P = 0.06). Significantly more MU/MM transplant recipients had breakthrough infections with Herpes simplex virus type 1 (HSV-1, P = 0.003), and more CMV reactivation (P = 0.015). The mortality rate in all patients during hospitalisation post-SCT was 6.3% in MR and 18.2% in MU/MM allo-SCT recipients (P = 0.009). Early mortality was associated with infection in 70% of the patients, with a similar distribution between MR and MU/MM transplant recipients. However, MU/MM transplant recipients had significantly more early deaths due to toxic causes (P < 0.001). We conclude that early post-transplant MU/MM transplant recipients tend to have more documented infections, and have significantly more breakthrough infections with HSV-1 and more CMV reactivation. MU/MM transplant recipients are at higher risk of early mortality, especially due to toxic causes.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Bacterial Infections / etiology
  • Bacterial Infections / microbiology
  • Female
  • Fever / etiology
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Hematopoietic Stem Cell Transplantation / mortality
  • Histocompatibility*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Mycoses / etiology
  • Mycoses / microbiology
  • Opportunistic Infections / etiology
  • Opportunistic Infections / immunology*
  • Opportunistic Infections / mortality
  • Retrospective Studies
  • Time Factors
  • Transplantation, Homologous / adverse effects
  • Transplantation, Homologous / immunology
  • Transplantation, Homologous / mortality
  • Virus Diseases / etiology
  • Virus Diseases / microbiology