Fewer infections and lower infection-related mortality following non-myeloablative versus myeloablative conditioning for allotransplantation of patients with lymphoma

• Published in: Bone marrow transplantation (Basingstoke) Vol. 43; no. 3; pp. 237 - 244
• Main Authors: BACHANOVA, V, BRUNSTEIN, C. G, BURNS, L. J, MILLER, J. S, LUO, X, DEFOR, T, YOUNG, J.-A. H, WEISDORF, D. J, TOMBLYN, M
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.02.2009
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Bacterial diseases; Bacterial infections; Biological and medical sciences; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Care and treatment; Conditioning; Cytomegalovirus; Density; Female; Fungal infections; Fungi; Health risks; Hematologic and hematopoietic diseases; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Humans; Immune reconstitution; Infection; Infection - etiology; Infection - mortality; Infections; Invasiveness; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Leukocytes (neutrophilic); Lymphoma; Lymphoma - microbiology; Lymphoma - therapy; Lymphomas; Male; Medical sciences; Middle Aged; Mortality; Patient outcomes; Patients; Prognosis; Risk factors; Stem cell transplantation; Stem cells; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation Conditioning - adverse effects; Transplantation Conditioning - methods; Transplants & implants; Viral infections; United States; Human; post transplant infections; Hematology; Mortality; Homograft; Malignant hemopathy; Transplantation; Non myeloablative treatment; Lymphoid neoplasm; Homotransplantation; Lymphoma; non-myeloablative conditioning; Infection; Treatment; Surgery; Lymphoproliferative syndrome; Graft; Myelosuppression; allogeneic transplantation; Comparative study; Cancer
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/bmt.2008.313

Non-myeloablative (NMA) allogeneic donor SCT for patients with relapsed lymphoma is associated with lower treatment-related mortality (TRM). However, the impact of conditioning intensity on post transplant infections remains unclear. We evaluated infections in 141 consecutive patients with lymphoma who were allografted using NMA (n=76) or myeloablative (MA; n=65) conditioning regimens. Using infection incidence density per 1000 patient days, we accounted for all infectious episodes during the first post transplant year. Before neutrophil engraftment, the NMA cohort had a 53% lower rate of bacterial infection (relative risk=0.47; P=0.06), whereas after engraftment the density of bacterial infections was similar in the two groups. In the first month, both invasive fungal infections and viral infections were twofold less frequent (P=0.22; P=0.06) in NMA patients. Late viral and fungal infections as well as CMV reactivation were infrequent after either conditioning intensity. The 1-year infection-related mortality was significantly lower after NMA conditioning (NMA 9% (3-16%) vs MA 22% (11-40%); P=0.03). NMA allogeneic transplantation for lymphoma patients results in substantially fewer early infections and lower infection-related deaths, although the similar frequency of later infections suggests that immune reconstitution is delayed with either conditioning intensity.