Impact of cumulative steroid dose on infectious diseases after allogenic hematopoietic stem cell transplantation.

Abstract

Systemic steroid is used to treat various transplant-related complications after allogenic hematopoietic stem cell transplantation (allo-HSCT). However, measures to evaluate its impact on infections are still limited. Hence, we examined the cumulative steroid dose used within 30days after transplant as a predictor of future risk of infections. This study included 226 patients who underwent their first allo-HSCT at Kyoto University Hospital between 2005 and 2015. Sixty-one patients received transplantation from related donors, 106 received unrelated BMT and 59 received unrelated single-unit CBT. Patients were categorized into three groups according to the cumulative steroid dose in terms of prednisolone: no-steroid group (n=174), low-dose group (≤7mg/kg) (n=22) and high-dose group (>7mg/kg) (n=30). In a multivariate analysis, high-dose steroid administration was associated with cytomegalovirus (CMV) antigenemia (HR 1.91, P=0.037) and bacteremia (HR 2.59, P=0.053). No impact was found on the occurrence of invasive fungal infection. High-dose cumulative steroid could predict high risks of bacteremia and CMV antigenemia. Additional anti-bacterial agents for fever and regular measurement of CMV antigen are recommended for whom with systemic steroid administration even after neutrophil engraftment.