G-CSF-primed haplo-identical HSCT with intensive immunosuppressive and myelosuppressive treatments does not increase the risk of pre-engraftment bloodstream infection: a multicenter case–control study
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A multicenter retrospective study in 131 patients (44 females/87 males) with hematological disorders who underwent G-CSF-primed/haplo-identical (Haplo-ID) (n = 76) or HLA-identical (HLA-ID) HSCT (n = 55) from February 2013 to February 2016 was conducted to compare the incidence and risk factors for pre-engraftment bloodstream infection (PE-BSI). In the Haplo-ID group, 71/76 patients with high-risk (n = 28) or relapsed/refractory hematological malignancies (n = 43) received FA5-BUCY conditioning (NCT02328950). All received trimethoprim–sulfamethoxazole (TMP–SMX) prophylaxis. Blood cultures and catheter tip cultures were obtained to confirm the BSI. PE-BSI was detected in 24/131 HSCT patients (18/76 in Haplo-ID and 6/55 in HLA-ID) after 28 febrile neutropenic episodes. Among 28 isolates for the 24 patients, 21 (75%) were Gneg bacteria, 6 (21.4%) Gpos and 1 (3.6%) fungi. Bacteria sources were central venous line infection (7/29.2%), gastroenteritis (6/25%), lower respiratory tract infection (LRTI; 5/20.8%), perianal skin infection (4/16.7%), and unknown (2/8.3%). The duration of neutropenia (P = 0.046) and previous Gneg bacteremia (P = 0.037) were important risk factors by univariate analysis, while the type of HSCT was not. A trend of TMP–SMX-resistant BSI in both groups may be due to routine antibacterial prophylaxis strategies. Our data show that G-CSF-primed Haplo-ID HSCT did not increase the risk of PE-BSI, even with intensive immunosuppressive treatments.
KeywordsHaplo-identical HSCT Immunosuppressive and myelosuppressive treatments Pre-engraftment Bloodstream infection
This work was supported in part by the National and Fujian Provincial Key Clinical Specialty Discipline Construction Program, China; National High Technology Research and Development Program of China; 863 program (2012AA02A505); National Public Health Grand Research Foundation (201202017); National Natural Science Foundation of China (81570162, 81700131, 81870138); Fujian Provincial Key Laboratory Foundation of Hematology (2009J1004); and Natural Science Foundation of Fujian Province (2017Y9017, 2017Y9037, 2017Y9056, 2018Y0031). The authors would like to thank all the nurses and physicians at the center who all contributed to the management of patient care, and Dr. Martine Torres for her critical reading of the manuscript and editorial assistance.
Prof. Jianda Hu and Prof. Ting Yang designed and performed the research. Dr. Jinhua Ren and Dr. Qiaoxian Ling collected the data. Dr. Qiaoxian Ling performed the statistical analyses. Prof. Ting Yang interpreted the data and wrote the manuscript. All authors participated in the management of patient care. All authors critically reviewed and approved the manuscript.
Compliance with ethical standards
This study was conducted in accordance with the ethical standards of the local institutional review board (the Medical Ethics Committee of Fujian Medical University Union Hospital and the Helsinki Declaration). Informed consent was obtained from all patients and donors before they were included in the study.
Conflict of interest
The authors declare that they have no competing interests.
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