Severe infections after single umbilical cord blood transplantation in adults with or without the co‐infusion ofCD34⁺cells from a third‐party donor: results of a multicenter study from the Grupo Español de Trasplante Hematopoyético (GETH)

Abstract

These data show that sCBT supported with TPDCD34(+) cells results in much shorter periods of post-transplant leukopenia, but the short- and long-term rates of IRM were comparable to those of sCBT, presumably because immune recovery is equally delayed in both graft types.

Infectious Complications After Umbilical Cord-Blood Transplantation From Unrelated Donors

“…Finally, no differences have been found in outcome after IFI, with a similar mortality rate after UCBT or transplant with other stem cell sources ranging from 7% to 86% 13,21,30,32,36,41,43…”

“…However, few studies have specificaly adressed this issue in the UCBT setting 30,33,34,35. Some of these studies have included a relatively small number of patients with few documented infections or have reported bacterial infections together with other severe infections 6,12,13,14,32,36,37. It is, therefore, difficult to draw definite conclusions from these studies and efforts to better define the epidemiology, clinical characteristics, outcome and prognostic factors of bacterial infections after UCBT are warranted.…”

“…Described incidence varies among different transplantation centers depending on many factors such as the geographical region, patients diagnosis, conditioning, period of neutropenia and type of primary prophylaxis 7,12,13,14,21,30,32,36,37,39–43…”

“…Most common sites of IFI were invasive pulmonary infections followed by brain abscess and disseminated fungal infection. Of the sixty-three documented fungal infections published in the literature, 35 episodes of fungemia were caused by Candida , 19 by Aspergillus , 2 by Scedosporium , 2 by Zygomycetes, 1 by Cryptococcus, 1 by Saccharomyces, 1 by Fusarium, 1 by Trichosporon and 1 by Rhizopus 6,12,13,14,30,36,37,41,42. A higher proportion of IFIs before day +100 after UCBT compared to bone marrow or peripheral blood stem cell transplantation has been suggested 32.…”

“…In view of these concerns, several strategies have been explored to enhance engraftment and shorten neutropenia, such as the infusion of double-cord blood units, CD34+ cells ex-vivo expansion or co-infusion of CD34+ cells from a third-party donor. Regrettably, none of these new approaches has shown clear benefits compared with using a single un-manipulated cord blood unit 13,14,15,16…”