1542. Infectious Complications in Patients Following Umbilical Cord Blood Transplant (UCBT) for Hematologic Malignancy

BACKGROUND: UCBT can be performed in pt with hematologic malignancies who do not have a matched donor, but engraftment often takes longer than with a standard allogeneic stem cell transplant. Delayed engraftment can increase the risk for infections, but characteristics of specific infections & outcomes have not been well characterized in adults undergoing UCBT. METHODS: All adults who underwent UCBT between January 1, 2006 and January 1, 2016 at our two centers were included. Infectious episodes within 6 months before and up to 2 years after UCBT were reviewed. RESULTS: Fifty-seven patients underwent UCBT. Mean age was 43 ± 14 years, and 34 patients were women. Thrity-nine (60%) had acute leukemia. Only 47 patients had neutrophil engraftment. One hundred and seventy-nine infectious episodes occurred in 55 patients, 73 (41%) within 30 days post-UCBT. Viruses caused 85 (47%) infections. HHV-6 occurred in 28 episodes, 24 of which were viremia alone, and was most common within 30 days of UCBT. One patient died of HHV-6 encephalitis. CMV caused 32 infectious episodes, 24 of which were viremia only, was most common from Days 30–100, and caused no deaths. BK viruria occurred in 18 episodes. Bacteria were responsible for 82 (46%) infections; most common were bacteremias due to Staphylococcus, van-R Enterococcus and Enterobacteriaceae. Three patients had mycobacterial infections, two of which were fatal. Of 11 invasive fungal infections (IFI), nine were invasive aspergillosis, of which four were fatal. Overall mortality was 56% in the first year, including 13 deaths from infection. Eleven of these 13 infections occurred in the first 100 days post-UCBT and seven of them in the first 30 days. Patients who died within 100 days were significantly more likely to have had IFI (P = 0.04) or infection with VRE (P = 0.03) or Enterobacteriaceae (P = 0.03) within 30 days after UCBT. Among the 10 patients who never had neutrophil engraftment, nine died within 100 days post-UCBT, six from infection. CONCLUSION: Infectious complications were common after UCBT, especially in the first 30 days. Deaths from viral infections were fewer than expected, most likely because of increased screening and prophylaxis for CMV infections. Delayed engraftment and nonengraftment continue to convey increased risk for fatal bacterial and fungal infections post-UCBT. DISCLOSURES: All authors: No reported disclosures.