Bloodstream infection after umbilical cord blood transplantation using reduced-intensity stem cell transplantation for adult patients

Biol Blood Marrow Transplant. 2005 Jun;11(6):429-36. doi: 10.1016/j.bbmt.2005.01.010.

Abstract

Bloodstream infection (BSI) is a significant problem after cord blood transplantation (CBT). However, little information has been reported on BSI after reduced-intensity CBT (RI-CBT). We retrospectively reviewed the medical records of 102 patients. The median age of the patients was 55 years (range, 17-79 years). Preparative regimens comprised fludarabine 125 to 150 mg/m 2 , melphalan 80 to 140 mg/m 2 , or busulfan 8 mg/kg and total body irradiation 2 to 8 Gy. Prophylaxis against graft-versus-host disease comprised cyclosporin or tacrolimus. BSI developed within 100 days of RI-CBT in 32 patients. The cumulative incidence of BSI was 25% at day 30 and 32% at day 100. The median onset was day 15 (range, 1-98 days). Causative organisms included Pseudomonas aeruginosa (n = 12), Staphylococcus epidermidis (n = 11), Staphylococcus aureus (n = 6), Enterococcus faecium (n = 4), Enterococcus faecalis (n = 4), Stenotrophomonas maltophilia (n = 4), and others (n = 7). Of the 32 patients with BSI, 25 (84%) died within 100 days after RI-CBT. BSI was the direct cause of death in 8 patients (25%). Univariate analysis failed to identify any significant risk factors. BSI clearly represents a significant and fatal complication after RI-CBT. Further studies are warranted to determine clinical characteristics, identify patients at high risk of BSI, and establish therapeutic strategies.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Bacteremia* / drug therapy
  • Bacteremia* / etiology
  • Bacteremia* / microbiology
  • Bacteremia* / mortality
  • Cord Blood Stem Cell Transplantation* / mortality
  • Female
  • Graft vs Host Disease / microbiology
  • Graft vs Host Disease / prevention & control
  • Hematologic Diseases / therapy
  • Humans
  • Immunosuppression Therapy / adverse effects
  • Incidence
  • Male
  • Middle Aged
  • Neoplasms / therapy
  • Retrospective Studies
  • Risk Factors