Relationship of Oropharyngeal Colonization Microorganisms to Clinical Outcomes within 100 Days after Allogeneic Hematopoietic Stem Cell Transplantation

Jianrong, Ge; Wei, Xiya; Gu, Yue; Xie, Yonghui; Huiyu, Li; Zhou, Siying; Liu, Chenchen; Shijia, Li; Wu, Wei; Jie, Xu; Ma, Xiao; Tang, Zaixiang; He, Jun; Wu, Depei; WU, Xiaojin; Liu, Jisheng

doi:10.1016/j.jtct.2022.05.017

Cited by 5 publications

(4 citation statements)

References 45 publications

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“…KP colonization is particularly pervasive in patients in ICUs, and previous studies have shown that colonization by carbapenem-resistant KP (CRKP) can affect between 15.2% and 49% of patients in ICUs ( 15 – 17 ), which increases the risk of severe morbidity and mortality for these patients ( 18 ). One previous study suggested that KP is the bacteria that most frequently colonizes the pharynx of allo-HSCT recipients ( 19 ), which is consistent with other reports ( 20 – 22 ).…”

Section: Introductionsupporting

confidence: 91%

A clinical predictive model for pre-transplantation Klebsiella pneumoniae colonization and relevance for clinical outcomes in patients receiving allogeneic hematopoietic stem cell transplantation

Zhang,

Wu,

et al. 2024

Microbiol Spectr

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The purpose of this study is to establish a clinical prediction model to discriminate patients at high risk of Klebsiella pneumoniae (KP) colonization before allogeneic hematopoietic stem cell transplantation (allo-HSCT) and evaluate the impact of KP colonization on clinical outcomes after allo-HSCT. We retrospectively collected data from 2,157 consecutive patients receiving allo-HSCT between January 2018 and March 2022. KP colonization was defined as a positive test for KP from a pharyngeal or anal swab before allo-HSCT. Logistic regression was used to build a clinical prediction model. Cox regression analyses were performed to explore the effect of KP colonization on clinical outcomes. Among all the inpatients, 166 patients had KP colonization and 581 with no positive pathogenic finding before transplantation. Seven candidate predictors were entered into the final prediction model. The prediction model had an area under the curve of 0.775 (95% CI 0.723–0.828) in the derivation cohort and 0.846 (95% CI: 0.790–0.902) in the validation cohort. Statistically significantly different incidence rates were observed among patient groups with clinically predicted low, medium, and high risk for KP infection ( P < 0.001). The presence of KP colonization delayed platelet engraftment ( P < 0.001) and patients with KP colonization were more likely to develop KP bloodstream infections within 100 days after allo-HSCT ( P < 0.0001). Patients with KP colonization had higher non-relapse mortality ( P = 0.032), worse progression-free survival ( P = 0.0027), and worse overall survival within 100 days after allo-HSCT ( P = 0.013). Our findings suggest that increased awareness of risks associated with pre-transplantation bacterial colonization is warranted. IMPORTANCE Several studies have identified that Klebsiella pneumoniae (KP) is among the most common and deadly pathogens for patients in hospital intensive care units and those receiving transplantation. However, there are currently no studies that evaluate the impact of KP colonization to patients undergoing allogeneic hematopoietic stem cell transplantation. Our results confirm that pre-existing KP colonization is relatively common in a hematology transplant ward setting and negatively affects post-transplantation prognosis. Our clinical prediction model for KP colonization can support early intervention in patients at high risk to avoid subsequent bloodstream infections and improve survival outcomes. Altogether, our data suggest that increased awareness of risks associated with pre-transplantation bacterial colonization is warranted. Future studies are needed to confirm these findings and to test early intervention strategies for patients at risk of complications from KP infection.

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Section: Introductionsupporting

confidence: 91%

A clinical predictive model for pre-transplantation Klebsiella pneumoniae colonization and relevance for clinical outcomes in patients receiving allogeneic hematopoietic stem cell transplantation

Zhang,

Wu,

et al. 2024

Microbiol Spectr

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“…Platelet recovery was defined as a platelet count greater than 20 × 10 9 /L on the first day of seven consecutive days without platelet transfusion [ 16 ]. EBV and CMV activation were defined as DNA viral load monitoring points with more than 100 copies/mL [ 17 ]. GRFS was defined as the first occurrence among grade III–IV acute GVHD, extensive chronic GVHD, relapse, or death [ 18 ].…”

Section: Methodsmentioning

confidence: 99%

Allogenic hematopoietic stem cell transplantation outcomes of patients aged ≥ 55 years with acute myeloid leukemia or myelodysplastic syndromes in China: a retrospective study

Gao,

Yang,

Zhou

et al. 2024

Stem Cell Res Ther

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Background Elderly patients with acute myeloid leukemia or myelodysplastic syndromes (AML/MDS) have historically had poor prognoses. However, there has been a recent increase in the use of allogenic hematopoietic stem cell transplantation (allo-HSCT) are in this patient population. Nevertheless, the optimal choice of donor type for the patients remains an unmet need. Limited data exist on the use of allo-HSCT in elderly patients with AML/MDS from China. To better understand and optimize the selection of donor type for the elderly patients, particularly for those with refractory or relapsed disease, in comparison with the previous studies in the US and Europe. Methods Our retrospective study enrolled 259 patients aged over 55 years who underwent their first allo-HSCT between April 2015 and August 2022. These patients were divided into three groups based on donor type: haploidentical related donor group (haploidentical related donor transplantation [HID], n = 184), matched sibling donor group (matched sibling donor transplantation [MSD], n = 39), and matched unrelated donor group (matched unrelated donor transplantation [MUD], n = 36). Statistics were performed with the chi-square test, the log-rank and Fine-Gray tests. Results The median age of the cohort was 57 years (range: 55–75) and 26.25% of patients were over 60 years old. Younger patients had a higher incidence of acute graft-versus-host disease (HR = 1.942, P = 0.035), faster neutrophil recovery (HR = 1.387, P = 0.012), and better overall survival (HR = 0.567, P = 0.043) than patients aged ≥ 60 years across the entire cohort. Patients with refractory or relapsed (R/R) diseases had delayed neutrophil engraftment (P = 0.010, HR = 0.752) and platelet engraftment (P < 0.001, HR = 0.596), higher incidence of relapses (HR = 2.300, P = 0.013), and inferior relapse-free survival (RFS) (HR = 1.740, HR = 0.016) regardless of donor type. When it came to graft-versus-host-disease-free, relapse-free survival (GRFS), MUDs turned out to be superior to HIDs (HR = 0.472, P = 0.026) according to the multivariable analysis. In contrast, we found MSDs had an inferior GRFS to HIDs in parallel (HR = 1.621, P = 0.043). Conclusion The choice of donor type did not significantly affect the outcomes of allo-HSCT. However, when considering the quality of post-transplant life, MUDs or HIDs from younger donors may be the optimal choice for elderly patients.

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“…Acute and chronic GVHD (Graft‐Versus‐Host‐Disease) (aGVHD and cGVHD) were diagnosed and graded according to standard clinical criteria 19,20 . Cytomegalovirus (CMV) or Epstein–Barr virus (EBV) reactivation was defined as a CMV DNA viral load >100 copies/mL or an EBV DNA viral load >100 copies/mL at any time after HSCT on at least 1 measurement 21 . Transplant‐associated thrombotic microangiopathy (TA‐TMA) was diagnosed in HSCT recipients with either histologic evidence of TMA on tissue sample or diagnostic markers appearing at the same time 22,23 .…”

Section: Methodsmentioning

confidence: 99%

“…19,20 Cytomegalovirus (CMV) or Epstein-Barr virus (EBV) reactivation was defined as a CMV DNA viral load >100 copies/mL or an EBV DNA viral load >100 copies/ mL at any time after HSCT on at least 1 measurement. 21 Transplant-associated thrombotic microangiopathy (TA-TMA) was diagnosed in HSCT recipients with either histologic evidence of TMA on tissue sample or diagnostic markers appearing at the same time. 22,23 Relapse was defined as a recurrence of the underlying hematologic malignant disease.…”

Section: Assessment Of Engraftment Gvhd and Survivalmentioning

confidence: 99%

The impact of pre‐transplant anti‐HLA antibodies in transplants from HLA‐identical sibling donors: A multicenter study

Wei,

Chang,

Zhu

et al. 2023

HLA

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Few studies have performed comparative analysis of the outcome of hematopoietic stem cell transplantation from HLA‐identical sibling donors (ISD‐HSCT) in patients with or without anti‐HLA Abs. In this study we retrospectively collected data from a multicenter study to analyze the distribution and impact of the pre‐existing anti‐HLA Abs in ISD‐HSCT. Among 402 recipients, 111 were positive for anti‐HLA Abs. Gender, time from diagnosis to transplantation and distribution of primary disease might be risk factors for the occurrence of anti‐HLA Abs. We found that patients with anti‐HLA Abs had delayed neutrophil engraftment and were more vulnerable to experience Cytomegalovirus (CMV) reactivation. The presence of anti‐HLA Abs was proved to be an independent risk factor for neutrophil engraftment (HR 1.42 95% CI 1.13–1.80, p = 0.003) and CMV reactivation (HR 2.03 95% CI 1.19–3.46, p = 0.009). We found that anti‐HLA Abs have a negative impact on the prognosis in the early period after transplantation from sibling donors and anti‐HLA Abs was also an independent risk factor for the overall survival (OS) at 180 days (HR 2.32, 95% CI 1.03–5.27, p = 0.042) among female recipients. In conclusion, anti‐HLA Abs have a negative impact on the prognosis early after ISD‐HSCT.

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Relationship of Oropharyngeal Colonization Microorganisms to Clinical Outcomes within 100 Days after Allogeneic Hematopoietic Stem Cell Transplantation

Cited by 5 publications

References 45 publications

A clinical predictive model for pre-transplantation Klebsiella pneumoniae colonization and relevance for clinical outcomes in patients receiving allogeneic hematopoietic stem cell transplantation

A clinical predictive model for pre-transplantation Klebsiella pneumoniae colonization and relevance for clinical outcomes in patients receiving allogeneic hematopoietic stem cell transplantation

Allogenic hematopoietic stem cell transplantation outcomes of patients aged ≥ 55 years with acute myeloid leukemia or myelodysplastic syndromes in China: a retrospective study

The impact of pre‐transplant anti‐HLA antibodies in transplants from HLA‐identical sibling donors: A multicenter study

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