Comparison of Infectious Complications in Patients Receiving High-Dose Cyclophosphamide as GvHD Prophylaxis After Transplantation From A 9/10 HLA-Matched Unrelated Donor with Standard GvHD Prophylaxis After Transplant From A Fully Matched Related Donor.

IF 2 4区医学 Q3 HEMATOLOGY

Mediterranean Journal of Hematology and Infectious Diseases Pub Date : 2024-03-01 eCollection Date: 2024-01-01 DOI:10.4084/MJHID.2024.016

Selim Sayýn, Murat Yýldýrým, Melda Cömert, Bilge Uğur, Esra Şafak Yýlmaz, Ferit Avcu, Ali Uğur Ural, Meltem Aylı

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引用次数: 0

Abstract

Background: The aim of this study was to evaluate whether cyclophosphamide administered after allogeneic stem cell transplantation (ASCT) from 9/10 HLA-Matched Unrelated Donors (MMUD) increases the rates of bacterial, fungal, viral infections, complications (hemorrhagic cystitis (HC)), and infection-related mortality compared to allogeneic stem cell transplantation from matched related donors (MRD).

Methods: This is a retrospective multicenter study. 45 MMUD ASCT patients who received posttransplant cyclophosphamide+methotrexate+calcineurin inhibitor compared with 45 MRD ASCT patients who received methotrexate+calcineurin inhibitor.

Results: Although there was a statistically significant prolongation of neutrophil engraftment time in the PTCy arm, there was no statistically significant difference in bacterial infection frequencies between the groups (PTCy; 9 (20%), control; 8 (17.8%), p=0.778). The distribution of CMV infection in the first 100 days was similar (p=0.827), but the distribution of CMV infection rate between the 100th and 365th days was observed more frequently in the control group (p=0.005). HC rates and their grades were similar in both groups (PTCy; 4 (8.8%), control; 6 (13.3%) p=0.502). The rates of VZV infection and invasive aspergillosis were similar in the PTCy and control groups (13.3% in the PTCy and 17.8% in the control group p=0.561). There is also no statistically significant difference in survival analysis (OS, LFS, GRFS, RI, IRM, NRM) between groups. However, the incidence of cGVHD was significantly higher in the control group (P=0.035).

Conclusions: The addition of PTCy to standard GvHD prophylaxis in MMUD ASCT does not lead to an increase in CMV reactivation, bacterial infections, invasive fungal infection, viral hemorrhagic cystitis, or mortality.

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从 9/10 HLA 匹配的非亲缘供体进行移植后接受大剂量环磷酰胺作为 GvHD 预防措施的患者与从完全匹配的亲缘供体进行移植后接受标准 GvHD 预防措施的患者的感染并发症比较。

背景：本研究旨在评估与配型相合的亲属供者（MRD）异基因干细胞移植相比，9/10 HLA配型相合的非亲属供者（MMUD）异基因干细胞移植（ASCT）后给予环磷酰胺是否会增加细菌、真菌、病毒感染、并发症（出血性膀胱炎（HC））和感染相关死亡率：这是一项回顾性多中心研究。45名接受环磷酰胺+甲氨蝶呤+钙调素抑制剂移植后的MMUD ASCT患者与45名接受甲氨蝶呤+钙调素抑制剂移植后的MRD ASCT患者进行了比较：虽然PTCy组的中性粒细胞移植时间明显延长，但两组间的细菌感染率差异无统计学意义（PTCy组9例（20%），对照组8例（17.8%），P=0.778）。前 100 天的 CMV 感染分布情况相似（P=0.827），但对照组在第 100 天和第 365 天之间的 CMV 感染率分布更频繁（P=0.005）。两组的 HC 感染率及其等级相似（PTCy：4（8.8%），对照组：6（13.3%），P=0.502）。PTCy 组和对照组的 VZV 感染率和侵袭性曲霉菌病发生率相似（PTCy 组为 13.3%，对照组为 17.8%，P=0.561）。各组间的生存分析（OS、LFS、GRFS、RI、IRM、NRM）也无统计学差异。然而，对照组的 cGVHD 发生率明显更高（P=0.035）：结论：在MMUD ASCT中，在标准GvHD预防措施的基础上增加PTCy不会导致CMV再激活、细菌感染、侵袭性真菌感染、病毒性出血性膀胱炎或死亡率的增加。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Mediterranean Journal of Hematology and Infectious Diseases Medicine-Hematology

CiteScore

4.20

自引率

6.20%

发文量

113

审稿时长

12 weeks

期刊介绍： Reciprocal interdependence between infectious and hematologic diseases (malignant and non-malignant) is well known. This relationship is particularly evident in Mediterranean countries. Parasitosis as Malaria, Leishmaniosis, B Hookworms, Teniasis, very common in the southeast Mediterranean area, infect about a billion people and manifest prevalently with anemia so that they are usually diagnosed mostly by experienced hematologist on blood or bone marrow smear. On the other hand, infections are also a significant problem in patients affected by hematological malignancies. The blood is the primary vector of HIV infection, which otherwise manifest with symptoms related to a reduction in T lymphocytes. In turn, infections can favor the insurgency of hematological malignancies. The causative relationship between Epstein-Barr virus infection, Helicobacter pylori, hepatitis C virus, HIV and lymphoproliferative diseases is well known.