Infection-related deaths in the haematopoietic stem cell transplant setting

Ref ID: 18550

Author:

J. Sinko, J. Csomor, A. Barta, L. Lengyel, E. Torbagyi, L. Gopcsa,
A. Batai, Z. Csukly, R. Nikolova, G. Benyo, K. Kallay, G. Krivan,
P. Remenyi, T. Masszi

Author address:

St. Istvan & St Laszlo Hospital (Budapest, HU)

Full conference title:

Annual Meeting of the EBMT, 38th

Abstract:

Background: For decades infections have been among the
major causes of death in patients undergoing hematopoietic
stem cell transplantation (HSCT). In the era of novel diagnostic
and therapeutic strategies, outcome variables should carefully
be monitored and re-evaluated.
Methods: In a single-center, retrospective survey data from a
total of 607 adult and pediatric patients (242 allogeneic and 365
autologous graft recipients) undergoing HSCT between 2008
and 2010 were analyzed. An autopsy was performed in all fatal
cases. Pathogens were identifi ed on morphological basis and
culture. No nucleic acid based tests were used on tissue specimens. A possible infectious cause of deaths was investigated
based on post mortem and clinical fi ndings. In cases of most
prevalent infections the time to death post transplantation was
also calculated. In mold infections results were compared to
historical control data.
Results: During the median follow-up time of 113 (1-891) days
77 (16 autografted and 61 allografted) patients died. In the autologous transplant population only 3 patients died of infection
[P470]S124
(bacterial: 1, mold infection: 2). Both of these mold infection
cases were heavily pretreated multiple myeloma patients dying
of an invasive aspergillosis. In the allogeneic HSCT setting 33
fatalities (55% of deaths) could be related to infection. Mold:
16 (25%), bacterial: 9 (15%), viral: 7 (11%), protozoon: 1 (2%)
and mold+viral double infection: 1 (2%). Compared to historical
control (same centre, between 2003-2006) a non-signifi cant
decrease in mold related deaths could be observed (7 vs. 8.2 %
of all allogeneic HSCT cases). While the rate of invasive aspergillosis-related deaths decreased, a minor increase was seen in
fatalities due to mucormycosis (4.5 vs. 6.1%, and 2.5 vs. 2% of
all allogeneic HSCT cases, respectively). Time to death due to
aspergillosis after HSCT was signifi cantly shorter when compared to mucormycosis (mean 98.8 vs. 178.5 days, p=0.05).
Conclusions: 1. Infectious mortality remains low in autologous
HSCT but infection is still a leading cause of death in the allogeneic HSCT setting. 2. Invasive mold infections can occur in
pretreated and autografted multiple myeloma patients. 3. The
incidence of fatal invasive aspergillosis slightly decreased in
allogeneic HSCT but the rate of mucormycosis showed a tendency to increase. 4. Fatal aspergillosis occurred signifi cantly
earlier post transplantation than deaths due to mucormycosis.

Abstract Number: P472

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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