Influence of protective isolation on outcome of allogeneic bone marrow transplantation for leukemia

• Published in: Bone marrow transplantation (Basingstoke) Vol. 21; no. 12; pp. 1231 - 1238
• Main Authors: PASSWEG, J. R, ROWLINGS, P. A, SCHAEFER, U. W, SOBOCINSKI, K. A, VOSSEN, J. M, ZHANG, M.-J, HOROWITZ, M. M, ATKINSON, K. A, BARRETT, A. J, GALE, R. P, GRATWOHL, A, JACOBSEN, N, KLEIN, J. P, LJUNGMAN, P, RUSSELL, J. A
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.06.1998
• Subjects: Adolescent; Adult; Air flow; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antibiotic Prophylaxis; Biological and medical sciences; Bone marrow; Bone marrow transplantation; Bone Marrow Transplantation - adverse effects; Bone marrow, stem cells transplantation. Graft versus host reaction; Child; Child, Preschool; Female; Filtration; Gloves; Hematologic and hematopoietic diseases; Histocompatibility antigen HLA; Humans; Hygiene; Infant; Infections; Isolation units; Leukemia; Leukemia - therapy; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Mortality; Regression analysis; Regression models; Risk assessment; Stem cell transplantation; Survival; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation, Homologous; Transplants; Human; Postoperative; Prognosis; Treatment efficiency; Leukemia; Homograft; Malignant hemopathy; Transplantation; Infection; Prevention; Bone marrow; Complication; Isolation
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1701238

Various isolation strategies are used to prevent infections during bone marrow transplantation; data on their efficacy are lacking. We studied whether use of high efficiency particulate air filtration (HEPA) and/or laminar airflow (LAF) units affect transplant-related mortality (TRM) or survival in the first year after allogeneic transplantation. 5065 patients with leukemia receiving bone marrow transplants from an HLA identical sibling (n = 3982) or alternative related or unrelated donors (n = 1083) between 1988 and 1992 were reported to the International Bone Marrow Transplant Registry by 222 teams. Two types of isolation were considered: (1) conventional protective isolation with single patient room and any combination of hand-washing, gloves, mask and gown; and (2) HEPA and/or LAF. Cox proportional hazards regression models were used to determine the relative risks (RRs) of transplant-related mortality (TRM) and of deaths from any cause in patients treated in HEPA/LAF units compared to patients treated in conventional isolation. HLA-identical sibling and alternative donor transplants were analyzed separately. Risks of TRM and overall mortality in the first 100 days post-transplant were significantly lower among patients treated in HEPA/LAF units than in those treated conventionally. RRs of TRM were 0.76 (P = 0.009) for recipients of HLA-identical sibling transplants and 0.65 (P = 0.003) for recipients of alternative donor transplants. Correspondingly RRs of overall mortality were 0.80 (P = 0.02) and 0.65 (P = 0.0006). Decreased risks of TRM and of death in the first 100 days post-transplant resulted in significantly higher 1-year survival rates in patients treated in HEPA/LAF rather than in conventional isolation units. Use of HEPA and/or LAF to prevent infections decreases TRM and increases survival after allogeneic bone marrow transplants for leukemia.