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Late‐occurring infections in a contemporary cohort of hematopoietic cell transplantation survivors
BACKGROUND: There is a paucity of studies describing the incidence and risk factors for late‐occurring (≥1 year) infectious complications in contemporary survivors of hematopoietic cell transplantation (HCT). METHODS: This was a retrospective cohort study of 641 1‐year survivors of HCT, transplanted...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8086032/ https://www.ncbi.nlm.nih.gov/pubmed/33835722 http://dx.doi.org/10.1002/cam4.3896 |
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author | Sy, Andrew Chanson, Dayana Berano Teh, Jennifer Wong, Florence L. Nakamura, Ryotaro Dadwal, Sanjeet Armenian, Saro H. |
author_facet | Sy, Andrew Chanson, Dayana Berano Teh, Jennifer Wong, Florence L. Nakamura, Ryotaro Dadwal, Sanjeet Armenian, Saro H. |
author_sort | Sy, Andrew |
collection | PubMed |
description | BACKGROUND: There is a paucity of studies describing the incidence and risk factors for late‐occurring (≥1 year) infectious complications in contemporary survivors of hematopoietic cell transplantation (HCT). METHODS: This was a retrospective cohort study of 641 1‐year survivors of HCT, transplanted between 2010 and 2013 as adults, and in remission from their primary disease. Standardized definitions were used to characterize viral, fungal, and bacterial infections. Cumulative incidence of infections was calculated, with relapse/progression considered as a competing risk event. Fine‐Gray subdistribution hazard ratio estimates and 95% confidence intervals (CI) were obtained, adjusted for relevant covariates. RESULTS: Median age at HCT was 55.2 years (range 18.1–78.1 years); 54.0% were survivors of allogeneic HCT. The 5‐year cumulative incidence of a late‐occurring infection for the entire cohort was 31.6%; the incidence of polymicrobial (≥2) infections was 10.1%. In survivors who developed at least one infection, the 5‐year incidence of a subsequent infection was 45.3%. Among allogeneic HCT survivors, patients with acute lymphoblastic (HR = 1.82 95% CI [1.12–2.96]) or myeloid (HR = 1.50 95% CI [1.02–2.20]) leukemia, and those with an elevated HCT‐Comorbidity index score (HR = 1.09 95% CI [1.01–1.17]) were more likely to develop late‐occurring infections; there was an incremental risk associated with severity of graft versus host disease (GVHD) at 1‐year post‐HCT (mild: HR = 2.17, 95% CI [1.09–4.33]; moderate/severe: HR = 3.78, 95% CI [1.90–7.53]; reference: no GVHD). CONCLUSIONS: The burden of late‐occurring infections in HCT survivors is substantial, and there are important patient‐ and HCT‐related modifiers of risk over time. These findings may help guide personalized screening and prevention strategies to improve outcomes after HCT. |
format | Online Article Text |
id | pubmed-8086032 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-80860322021-05-07 Late‐occurring infections in a contemporary cohort of hematopoietic cell transplantation survivors Sy, Andrew Chanson, Dayana Berano Teh, Jennifer Wong, Florence L. Nakamura, Ryotaro Dadwal, Sanjeet Armenian, Saro H. Cancer Med Clinical Cancer Research BACKGROUND: There is a paucity of studies describing the incidence and risk factors for late‐occurring (≥1 year) infectious complications in contemporary survivors of hematopoietic cell transplantation (HCT). METHODS: This was a retrospective cohort study of 641 1‐year survivors of HCT, transplanted between 2010 and 2013 as adults, and in remission from their primary disease. Standardized definitions were used to characterize viral, fungal, and bacterial infections. Cumulative incidence of infections was calculated, with relapse/progression considered as a competing risk event. Fine‐Gray subdistribution hazard ratio estimates and 95% confidence intervals (CI) were obtained, adjusted for relevant covariates. RESULTS: Median age at HCT was 55.2 years (range 18.1–78.1 years); 54.0% were survivors of allogeneic HCT. The 5‐year cumulative incidence of a late‐occurring infection for the entire cohort was 31.6%; the incidence of polymicrobial (≥2) infections was 10.1%. In survivors who developed at least one infection, the 5‐year incidence of a subsequent infection was 45.3%. Among allogeneic HCT survivors, patients with acute lymphoblastic (HR = 1.82 95% CI [1.12–2.96]) or myeloid (HR = 1.50 95% CI [1.02–2.20]) leukemia, and those with an elevated HCT‐Comorbidity index score (HR = 1.09 95% CI [1.01–1.17]) were more likely to develop late‐occurring infections; there was an incremental risk associated with severity of graft versus host disease (GVHD) at 1‐year post‐HCT (mild: HR = 2.17, 95% CI [1.09–4.33]; moderate/severe: HR = 3.78, 95% CI [1.90–7.53]; reference: no GVHD). CONCLUSIONS: The burden of late‐occurring infections in HCT survivors is substantial, and there are important patient‐ and HCT‐related modifiers of risk over time. These findings may help guide personalized screening and prevention strategies to improve outcomes after HCT. John Wiley and Sons Inc. 2021-04-09 /pmc/articles/PMC8086032/ /pubmed/33835722 http://dx.doi.org/10.1002/cam4.3896 Text en © 2021 The Authors. Cancer Medicine published by John Wiley & Sons Ltd. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Clinical Cancer Research Sy, Andrew Chanson, Dayana Berano Teh, Jennifer Wong, Florence L. Nakamura, Ryotaro Dadwal, Sanjeet Armenian, Saro H. Late‐occurring infections in a contemporary cohort of hematopoietic cell transplantation survivors |
title | Late‐occurring infections in a contemporary cohort of hematopoietic cell transplantation survivors |
title_full | Late‐occurring infections in a contemporary cohort of hematopoietic cell transplantation survivors |
title_fullStr | Late‐occurring infections in a contemporary cohort of hematopoietic cell transplantation survivors |
title_full_unstemmed | Late‐occurring infections in a contemporary cohort of hematopoietic cell transplantation survivors |
title_short | Late‐occurring infections in a contemporary cohort of hematopoietic cell transplantation survivors |
title_sort | late‐occurring infections in a contemporary cohort of hematopoietic cell transplantation survivors |
topic | Clinical Cancer Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8086032/ https://www.ncbi.nlm.nih.gov/pubmed/33835722 http://dx.doi.org/10.1002/cam4.3896 |
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