Infections after Transplantation of Bone Marrow or Peripheral Blood Stem Cells from Unrelated Donors.
Infections after Transplantation of Bone Marrow or Peripheral Blood Stem Cells from Unrelated Donors.
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DOI：
10.1016/j.bbmt.2015.09.013
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发表时间：
2016-02
期刊：
影响因子：
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通讯作者：
Blood and Marrow Transplant Clinical Trials Network Trial 0201
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文献类型：
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作者：
Young JH;Logan BR;Wu J;Wingard JR;Weisdorf DJ;Mudrick C;Knust K;Horowitz MM;Confer DL;Dubberke ER;Pergam SA;Marty FM;Strasfeld LM;Brown JWM;Langston AA;Schuster MG;Kaul DR;Martin SI;Anasetti C;Blood and Marrow Transplant Clinical Trials Network Trial 0201
感染是造血细胞移植的主要并发症。持续性中性粒细胞减少和移植物抗宿主病是两种主要并发症，具有相关的感染风险，这些并发症根据移植物来源而不同。一项3期、多中心、随机试验（BMT CTN 0201）比较了骨髓（BM）移植与来自无关供体（URD）的外周血干细胞（PBSC）移植，结果显示这些移植物来源之间的两年生存率无显著差异。为了提供关于骨髓或外周血干细胞是否可以用作移植的优先移植物来源的数据，我们报告了BMT CTN 0201试验移植后2年感染并发症的详细分析。本研究中共有499例患者接受了感染数据的全面稽查。384例（77%）患者共记录了1347例中度或更严重的感染事件; 201/249例（81%）可评价患者接受了BM移植物，183/250例（73%）接受了PBSC移植物。在1347例感染事件中，373例为重度，123例为危及生命和/或致死性;其中710例（53%）发生在BM组，637例（47%）发生在PBSC组，两年累积发生率为84.7%（95%置信区间[CI]：79.6-89.8）对比PBSC的79.7%（95%CI，73.9-85.5），P = 0.013。这些事件中的大多数，810（60%），是由于细菌，与72.1%和62.9%的骨髓与外周血干细胞接受者，分别为两年的累积发病率（P = 0.003）。前100天内血液细菌感染的累积发生率BM为44.8%（95%CI，38.5-51.1），PBSC为35.0%（95%CI，28.9-41.1）（P = 0.027）。BM和PBSC的总感染密度（感染事件数/ 100患者风险日）分别为0.67和0.60。两组中细菌感染的总体感染密度均为0.4;两组中病毒感染的总体感染密度均为0.2; BM和PBSC中真菌/寄生虫感染的总体感染密度分别为0.04和0.05。BM移植前感染的累积发生率为47.9%（95%CI，41.5-53.9），PBSC为32.8%（95%CI，27.1-38.7）（P = .002），可能与使用PBSC的更快中性粒细胞移植有关。URD HCT后感染仍然频繁，特别是BM移植后。
Infection is a major complication of hematopoietic cell transplantation. Prolonged neutropenia and graft versus host disease are the two major complications with an associated risk for infection, and these complications differ according to the graft source. A phase 3, multicenter, randomized trial (BMT CTN 0201) of transplantation of bone marrow (BM) versus peripheral-blood stem cells (PBSC) from unrelated donors (URD) showed no significant differences in two-year survival between these graft sources. In an effort to provide data regarding whether bone marrow or peripheral-blood stem cells could be used as a preferential graft source for transplantation, we report a detailed analysis of the infectious complications for 2 years following transplantation from the BMT CTN 0201 trial. A total of 499 patients in this study had full audits of infection data. A total of 1347 infection episodes of moderate or greater severity were documented in 384 (77%) patients; 201/249 (81%) of the evaluable patients had received a BM graft and 183/250 (73%) had received a PBSC graft. Of 1347 infection episodes, 373 were severe and 123 were life-threatening and/or fatal; 710 (53%) of these episodes occurred on the BM arm and 637 (47%) on the PBSC arm, resulting in a two-year cumulative incidence 84.7% (95% confidence interval [CI]: 79.6–89.8) for BM vs. 79.7% (95%CI, 73.9–85.5) for PBSC, P = .013. The majority of these episodes, 810 (60%), were due to bacteria, with a two-year cumulative incidence of 72.1% and 62.9% in BM versus PBSC recipients, respectively (P = .003). The cumulative incidence of bloodstream bacterial infections during the first 100 days was 44.8% (95%CI, 38.5–51.1) for BM vs. 35.0% (95%CI, 28.9–41.1) for PBSC (P = .027). The total infection density (# infection events / 100 patient days at risk) was .67 for BM and .60 for PBSC. The overall infection density for bacterial infections was .4 in both arms; for viral infections was .2 in both arms; and for fungal/parasitic infections was .04 and .05 for BM and PBSC, respectively. The cumulative incidence of infection prior to engraftment was 47.9% (95%CI, 41.5–53.9) for BM vs. 32.8% (95%CI, 27.1–38.7) for PBSC (P = .002), possibly related to quicker neutrophil engraftment using PBSC. Infections remain frequent following URD HCT, particularly following BM grafts.