Distinct Clinical Features of Infectious Complications in Adult T Cell Leukemia/Lymphoma Patients after Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Analysis in the Nagasaki Transplant Group

• Published in: Biology of blood and marrow transplantation Vol. 19; no. 4; pp. 607 - 615
• Main Authors: Itonaga, Hidehiro, Taguchi, Jun, Fukushima, Takuya, Tsushima, Hideki, Sato, Shinya, Ando, Koji, Sawayama, Yasushi, Matsuo, Emi, Yamasaki, Reishi, Onimaru, Yasuyuki, Imanishi, Daisuke, Imaizumi, Yoshitaka, Yoshida, Shinichiro, Hata, Tomoko, Moriuchi, Yukiyoshi, Honda, Sumihisa, Miyazaki, Yasushi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2013
• Subjects: Adolescent; Adult; Adult T cell leukemia-lymphoma; Aged; Allogeneic hematopoietic stem cell transplantation; Antifungal Agents - therapeutic use; Bacterial Infections - complications; Bacterial Infections - mortality; Bacterial Infections - pathology; Bacterial Infections - therapy; Cytomegalovirus; Cytomegalovirus Infections - complications; Cytomegalovirus Infections - mortality; Cytomegalovirus Infections - pathology; Cytomegalovirus Infections - therapy; Female; Fluconazole - therapeutic use; Hematology, Oncology and Palliative Medicine; Hematopoietic Stem Cell Transplantation; Humans; Infection; Itraconazole - therapeutic use; Japan; Leukemia, Myeloid, Acute - complications; Leukemia, Myeloid, Acute - mortality; Leukemia, Myeloid, Acute - pathology; Leukemia, Myeloid, Acute - therapy; Leukemia-Lymphoma, Adult T-Cell - complications; Leukemia-Lymphoma, Adult T-Cell - mortality; Leukemia-Lymphoma, Adult T-Cell - pathology; Leukemia-Lymphoma, Adult T-Cell - therapy; Male; Middle Aged; Mycoses - complications; Mycoses - mortality; Mycoses - pathology; Mycoses - therapy; Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality; Precursor Cell Lymphoblastic Leukemia-Lymphoma - pathology; Precursor Cell Lymphoblastic Leukemia-Lymphoma - therapy; Retrospective Studies; Survival Analysis; Transplantation, Homologous; Japan; Infection; Cytomegalovirus; Allogeneic hematopoietic stem cell transplantation; Adult T cell leukemia-lymphoma
• ISSN: 1083-8791; 1523-6536
• DOI: 10.1016/j.bbmt.2013.01.011

Abstract Although allogeneic hematopoietic stem cell transplantation (allo-SCT) is performed as a curative option in adult T cell leukemia-lymphoma (ATL) patients, its high transplantation-related mortality raises a serious issue. The clinical features of infectious complications after transplantation are not well known. To analyze the impact of infections after allo-SCT for ATL, we retrospectively compared infectious complications in 210 patients at 3 institutions in Nagasaki prefecture between 1997 and 2009. There were 91 patients with acute myeloid leukemia (AML), 51 with acute lymphoblastic leukemia/lymphoblastic lymphoma (ALL/LBL), and 68 with ATL. No patient received ganciclovir or foscarvir as prophylaxis, and most patients received antifungal prophylaxis with fluconazole or itraconazole. The cumulative incidence of cytomegalovirus (CMV) infection at 3 years was 69.2% in ATL patients versus 54.4% in AML patients ( P  = .0255). Cumulative infection-related mortality was significantly higher in ATL patients than in the 2 other groups (ATL versus AML, P  = .0496; ATL versus ALL/LBL, P  = .0075), and most death-causing pathogens were bacteria and fungus. The appearance of CMV infection was negatively associated with infectious mortality in ATL patients, but the P value for this association was near the borderline of significance ( P  = .0569). In multivariate analysis, transplantation using unrelated bone marrow and episodes of CMV infection were associated with worse overall survival in ATL patients, but were not in either AML or ALL/LBL patients. Collectively, the impact of infectious complications after transplantation in ATL patients was different from that in AML and ALL/LBL patients, suggesting that a more intensive strategy for infection control in ATL patients is required to reduce infectious mortality.