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G-CSF-primed haplo-identical HSCT with intensive immunosuppressive and myelosuppressive treatments does not increase the risk of pre-engraftment bloodstream infection: a multicenter casecontrol study

  • Jinhua Ren
  • Qiaoxian Lin
  • Weimin Chen
  • Congmeng Lin
  • Yuxin Zhang
  • Cunrong Chen
  • Shaozhen Chen
  • Xiaohong Yuan
  • Ping Chen
  • Xiaofeng Luo
  • Yun Lin
  • Lvying Shen
  • Mengxian Guo
  • Qiuru Chen
  • Min Xiao
  • Yongquan Chen
  • Xueqiong Wu
  • Yanling Zeng
  • Zhizhe Chen
  • Xudong Ma
  • Jianda Hu
  • Ting YangEmail author
Original Article
  • 78 Downloads

Abstract

A multicenter retrospective study in 131 patients (44 females/87 males) with hematological disorders who underwent G-CSF-primed/haplo-identical (Haplo-ID) (n = 76) or HLA-identical (HLA-ID) HSCT (n = 55) from February 2013 to February 2016 was conducted to compare the incidence and risk factors for pre-engraftment bloodstream infection (PE-BSI). In the Haplo-ID group, 71/76 patients with high-risk (n = 28) or relapsed/refractory hematological malignancies (n = 43) received FA5-BUCY conditioning (NCT02328950). All received trimethoprim–sulfamethoxazole (TMP–SMX) prophylaxis. Blood cultures and catheter tip cultures were obtained to confirm the BSI. PE-BSI was detected in 24/131 HSCT patients (18/76 in Haplo-ID and 6/55 in HLA-ID) after 28 febrile neutropenic episodes. Among 28 isolates for the 24 patients, 21 (75%) were Gneg bacteria, 6 (21.4%) Gpos and 1 (3.6%) fungi. Bacteria sources were central venous line infection (7/29.2%), gastroenteritis (6/25%), lower respiratory tract infection (LRTI; 5/20.8%), perianal skin infection (4/16.7%), and unknown (2/8.3%). The duration of neutropenia (P = 0.046) and previous Gneg bacteremia (P = 0.037) were important risk factors by univariate analysis, while the type of HSCT was not. A trend of TMP–SMX-resistant BSI in both groups may be due to routine antibacterial prophylaxis strategies. Our data show that G-CSF-primed Haplo-ID HSCT did not increase the risk of PE-BSI, even with intensive immunosuppressive treatments.

Keywords

Haplo-identical HSCT Immunosuppressive and myelosuppressive treatments Pre-engraftment Bloodstream infection 

Notes

Acknowledgments

This work was supported in part by the National and Fujian Provincial Key Clinical Specialty Discipline Construction Program, China; National High Technology Research and Development Program of China; 863 program (2012AA02A505); National Public Health Grand Research Foundation (201202017); National Natural Science Foundation of China (81570162, 81700131, 81870138); Fujian Provincial Key Laboratory Foundation of Hematology (2009J1004); and Natural Science Foundation of Fujian Province (2017Y9017, 2017Y9037, 2017Y9056, 2018Y0031). The authors would like to thank all the nurses and physicians at the center who all contributed to the management of patient care, and Dr. Martine Torres for her critical reading of the manuscript and editorial assistance.

Authors’ contributions

Prof. Jianda Hu and Prof. Ting Yang designed and performed the research. Dr. Jinhua Ren and Dr. Qiaoxian Ling collected the data. Dr. Qiaoxian Ling performed the statistical analyses. Prof. Ting Yang interpreted the data and wrote the manuscript. All authors participated in the management of patient care. All authors critically reviewed and approved the manuscript.

Compliance with ethical standards

This study was conducted in accordance with the ethical standards of the local institutional review board (the Medical Ethics Committee of Fujian Medical University Union Hospital and the Helsinki Declaration). Informed consent was obtained from all patients and donors before they were included in the study.

Conflict of interest

The authors declare that they have no competing interests.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Jinhua Ren
    • 1
  • Qiaoxian Lin
    • 1
    • 2
  • Weimin Chen
    • 3
  • Congmeng Lin
    • 4
  • Yuxin Zhang
    • 1
  • Cunrong Chen
    • 5
  • Shaozhen Chen
    • 1
  • Xiaohong Yuan
    • 1
  • Ping Chen
    • 1
  • Xiaofeng Luo
    • 1
  • Yun Lin
    • 3
  • Lvying Shen
    • 4
  • Mengxian Guo
    • 4
  • Qiuru Chen
    • 1
  • Min Xiao
    • 1
  • Yongquan Chen
    • 1
  • Xueqiong Wu
    • 1
  • Yanling Zeng
    • 1
    • 6
  • Zhizhe Chen
    • 1
  • Xudong Ma
    • 4
  • Jianda Hu
    • 1
  • Ting Yang
    • 1
    Email author
  1. 1.Department of Hematology, Fujian Institute of Hematology, Fujian Provincial Key Laboratory of HematologyFujian Medical University Union HospitalFuzhouPeople’s Republic of China
  2. 2.Department of HematologyThe First Affiliated Hospital of Fujian Medical UniversityFuzhouPeople’s Republic of China
  3. 3.Department of HematologyFujian Provincial HospitalFuzhouPeople’s Republic of China
  4. 4.Department of HematologyZhangzhou Affiliated Hospital of Fujian Medical UniversityZhangzhouPeople’s Republic of China
  5. 5.Department of Intensive Care UnitFujian Medical University Union HospitalFuzhouPeople’s Republic of China
  6. 6.Department of HematologyAffiliated Nanping First Hospital of Fujian Medical UniversityNanpingPeople’s Republic of China

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