Infectious complications after second allogeneic hematopoietic cell transplant in adult patients with hematological malignancies

Abstract

We conducted a retrospective review of the infectious complications and outcomes over a 2-year follow-up period of adult patients who received a second allogeneic hematopoietic cell transplant (2nd allo-HCT) during a five-year period at two cancer centers in Michigan. Sixty patients, of whom 44 (73%) had acute leukemia or myelodysplastic syndrome, were studied. The majority ( n = 37,62%) received a 2nd allo-HCT because of relapsed leukemia. Infection episodes after the 2nd allo-HCT totaled 112. Bacteria were identified in 76 episodes, the majority of which occurred pre-engraftment. The most common infecting organisms were Enterococcus species and Clostridioides difficile . Viral infections, predominantly cytomegalovirus, accounted for 59 infection episodes and occurred mostly in pre-engraftment and early post-engraftment periods. There were 16 proven/probable fungal infections, of which 9 were invasive aspergillosis or candidiasis. Mortality was 45% ( n = 27) at one year and 65% ( n = 39) at 2 years after transplant, and 16 deaths (41%) were due to infection. Of those 16 infection deaths, 8 were bacterial, 4 fungal, 2 both bacterial and fungal, and 2 viral. Failure to engraft neutrophils or platelets was significantly associated with decreased survival, p < 0.0001 and p < 0.001, respectively. Infections are common after a 2nd allo-HCT and are associated with a high mortality rate.

Incidence, Etiology, Risk Factors, and Outcomes of Bloodstream Infection after a Second Hematopoietic Stem Cell Transplantation

“…Previous studies have also reported that Enterococcus spp. were the major causative pathogens after the second HSCT and that previous HSCT was a risk factor for BSI with Enterococcus spp., which is consistent with the results of the present study ( 1 , 2 , 25 ). The risk of enterococcal infection increases as the duration of neutropenia increases, and in the present study, the high number of CBTs (characterized by a prolonged period of neutropenia) may have contributed to this increase ( 6 , 25 ).…”

“…A study of 37 second-HSCT recipients [including 25 (67.6%) patients who underwent the second HSCT for graft failure] also reported a higher cumulative incidence of pre-engraftment BSI (35.1%) after the second HSCT than after the first HSCT ( 2 ). In another study that included 60 second-HSCT recipients [including 16 (27%) patients who underwent the second HSCT for graft failure], most bacterial infections, including BSI, occurred during the pre-engraftment period ( 1 ). Previous reports have shown that the cumulative incidence of pre-engraftment BSI or BSI at day 30 after first allogeneic HSCT ranged from 1.7% to 34% (2-4, 18-20).…”

“…Continued improvements in hematopoietic stem cell transplantation (HSCT) technology have increased the feasibility and utilization of second HSCT procedures, which puts post-transplant recipients at an increased risk of worsening immunodeficiency. Infections after a second transplantation procedure can be common and are associated with high mortality ( 1 , 2 ). Nevertheless, studies on bloodstream infection (BSI) after second HSCT procedures are lacking.…”