Severe acute graft-versus-host disease increases the incidence of blood stream infection and mortality after allogeneic hematopoietic cell transplantation: Japanese transplant registry study

• Published in: Bone marrow transplantation (Basingstoke) Vol. 56; no. 9; pp. 2125 - 2136
• Main Authors: Inoue, Yoshitaka, Okinaka, Keiji, Fuji, Shigeo, Inamoto, Yoshihiro, Uchida, Naoyuki, Toya, Takashi, Ikegame, Kazuhiro, Eto, Tetsuya, Ozawa, Yukiyasu, Iwato, Koji, Kanda, Yoshinobu, Atsuta, Yoshiko, Ogata, Masao, Fukuda, Takahiro
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.09.2021; Nature Publishing Group
• Subjects: 692/499; 692/699/255; Acute Disease; Bacteremia; Blood; Cell Biology; Complications and side effects; Confidence intervals; Graft versus host disease; Graft versus host reaction; Graft vs Host Disease - etiology; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Homografts; Humans; Incidence; Infections; Internal Medicine; Japan - epidemiology; Medicine; Medicine & Public Health; Mortality; Multivariate analysis; Patient outcomes; Public Health; Registries; Retrospective Studies; Risk analysis; Risk factors; Sepsis; Stem cell transplantation; Stem Cells; Transplantation; Transplants & implants; Japan
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/s41409-021-01291-0

This study aimed to clarify the risk factors and prognosis associated with blood stream infection (BSI) in allogeneic hematopoietic cell transplantation (allo-HCT), and the relationship between BSI and acute graft-versus-host disease (aGVHD). This retrospective analysis included 11,098 patients in the Japanese national transplant registry. A total of 2172 patients developed BSI after allo-HCT, with 2332 identified pathogens. The cumulative incidences of BSI were 15.5% at 30 days and 20.9% at 100 days after allo-HCT. In a multivariate analysis, severe (grade III–IV) aGVHD was associated with a higher risk of BSI (vs. grade 0–I aGVHD: hazard ratio [HR] 3.34 [95% confidence interval (CI), 2.85–3.92; P  < 0.001]). In a multivariate analysis, severe aGVHD before BSI was associated with a higher risk of overall mortality after BSI (vs. grade 0–I aGVHD: HR 2.61 [95% CI 2.18–3.11; P  < 0.001]). In addition, BSI (vs. no-BSI: HR 1.20 [95% CI, 1.12–1.29; P  < 0.001]) and severe aGVHD (vs. grade 0–I aGVHD: HR 1.97 [95% CI, 1.83–2.12; P  < 0.001]) were independent risk factors for overall mortality after allo-HCT. In the setting of allo-HCT, severe aGVHD was associated with increases in both BSI incidence and post-BSI overall mortality. Furthermore, BSI was an independent risk factor for overall mortality.