Infectious complications after haploidentical T-cell replete transplantation (TR-H) and post-infusion cyclophosphamide (Cy): incidence, management and outcome

Elisa Mauro*, Luca Castagna, Barbara Sarina, Stefania Bramanti, Lucio Morabito, Armando Santoro

Author address: 

Rozzano, IT

Abstract: 

Background. Cord blood and haploidentical donors are more frequently searched for patients without HLA identical donors. With these alternative donors, immunosuppression must be reinforced and infections are frequent and severe. The objective of the study was to describe infectious complications after TR-H transplantation. 
Patients and Methods. Since April 2009 to September 2012, 46 patients with haematological malignancies underwent to TR-H. The source of stem cells was bone marrow. Conditioning regimens were NMA (n= 45, fludarabine, Cy and low dose TBI) and myeloablative (n= 3, thiotepa, fludarabine and busulfan). All patients received Cy at days +3 +4, tacrolimus and mycofenolate mofetil. Prophylaxis against molds, bacteria, and CMV was used. Three periods after HCT were defined: very early (0-30 days), early (31-100 days) and late (>100 days). 
Results. Overall, viral infections were diagnosed in 72% of patients, fungal infections occurrence in 6%, and bacterial infections in 39% (fig 1). 
In the very early period, 44 patients had fever. All had a thoracic CT scan at time of first febrile peak and 18% had pneumonia and 5 documented (2 CMV, 1 RSV, 1 H1N1, 1 Staph Aureus). 39% bacterial infections, and 39% viral infections, 4% fungal infections. 
In the early period, 53 infections were observed. Viral infections were documented 59% of patients (27 viremia, 7 BK virus cystitis, 1 CMV gastritis and 1 JC encephalitis), bacterial infections in 14% (3 gram positive bacteraemias and 1 clostridium colitis and 2 E coli cystitis), and fungal infections in 6%. Pneumonia was diagnosed in 15% of patients (5 non documented, 1 proven and 2 probable lung aspergillosis, 1 influenza pneumonia). 
In the late period, 32 infections were diagnosed. Viral infections were documented in 27% of patients (10 viremia, 2 pneumonias), bacterial infections in 16% (5 bacteraemias and 2 pneumonias) and fungal infection in 2% (hepato-splenic candidosis). 11% had pneumonia (3 no documented, 2 gram positive, 1 mycoplasma 1 RSV) (fig 2). 
Pneumonia incidence was 39% due to virus 33%, bacteria 22%, aspergillus 11%, and no documented 34%. 5 patients died from infections in the early period and all but one (JC virus encephalitis) related to pneumonia. 
Conclusion. Infectious complications were frequent after TR-H, mainly in the early period. Pneumonia were a cumbersome problem leading to 5 deaths. Invasive fungal infections incidence were low due to low incidence of GVHD. 

Tables: 

2013

Full conference title: 

Annual Meeting of European Society for Blood and Marrow Transplantation
    • EBMT 39th (2013)