The prognostic impact of previously infectious complications on allogeneic hematopoietic stem cell transplantation for patients with severe aplastic anemia: A single-center, retrospective study

Abstract

Whether infections before transplantation impair the survival of patients with severe aplastic anemia (SAA) remains unclear. The aim of this retrospective cohort analysis was to compare survival between patients with SAA who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) with infection (n=66) and patients without infection (n=189) from one medical center. There were no differences in baseline characteristics, except that more patients in the infection group were diagnosed with VSAA (59.09% vs. 30.69%, P<0.001), and their grafts were more peripheral blood stem cells (89.39% vs. 76.72%, P=0.042). In addition, the percentage of patients with multidrug-resistant organism colonization or infection in the infection group was larger (16.7% vs. 0.5%, P<0.001). The median days of engraftment were similar between the two groups; however, the 28-day engraftment rates of neutrophils and platelets were lower in the infection group. No differences were observed in terms of grades II–IV acute graft-versus-host disease (aGVHD) (P=0.418), grades III–IV aGVHD (P=0.075), mild to severe chronic GVHD (cGVHD) (P=0.899), and moderate to severe cGVHD (P=0.342). Patients in the infection group had more bloodstream infections before engraftment (28.8% vs. 15.3%, P=0.016), and the primary cause of death was infection instead of aGVHD in contrast to patients without infection (16.7% vs. 4.2%, P=0.002). Finally, the estimated overall survival (OS), failure-free survival (FFS), and GVHD-free FFS at 5 years were 63% (95% CI, 51–78), 60% (95% CI, 47–74), and 55% (95% CI, 43–70) in patients with infection before transplantation versus 86% (95% CI, 81–92) (P<0.001), 82% (95% CI, 76–88) (P<0.001), and 75% (95% CI, 69–82) (P=0.003) in patients without infection before transplantation, respectively. Multivariate analysis identified haploidentical HSCT and pre-HSCT anti-infection response, defined as partial remission (PR) or stable disease (SD), as adverse factors of OS and FFS. In conclusion, our study demonstrated that SAA patients with infection defined as PR or SD but not complete remission before allo-HSCT showed inferior survival compared with patients without infection. Therefore, more attention should be paid to prophylaxis and complete control of infectious complications before transplantation among SAA patients.

Comparison of hematopoietic stem cell transplantation and immunosuppressive therapy as the first-line treatment option for patients with severe hepatitis−associated aplastic anemia

“…Furthermore, our result confirmed the importance of anti-infection response before HSCT in line with previous reports (41). Failure to complete remission before HSCT was associated with inferior survival in patients with SAA (42). It has been well documented that severe HAAA patients have high incidence of infection which is difficult to control in the immunocompromised state.…”

The Critical Exploration into Current Evidence behind the Role of the Nutritional Support in Adult Patients Who Undergo Haematogenic Stem Cell Transplantation

“…Haematogenic stem cell transplantation (HSCT) is a potentially curative, intensive but also challenging approach to treatment for a variety of haematological malignancies [ 1 , 2 , 3 , 4 , 5 ]. However, multiple factors can potentially induce changes in metabolism and body compositions at the time of HSCT, including a high dose of systemic anticancer therapy (SACT), steroids, immunosuppressors, and total body radiation (TBI) which can lead to complications such as mucositis, nausea, vomiting, decreased indigestion, infections, or graft-versus-host disease (GvHD) [ 1 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. Nutritional support prevents protein wasting, preserves the lean body mass and energy reserves, recontracts immunity, and diminishes the inflammatory response [ 15 , 16 , 17 , 18 ].…”