Latent tuberculosis in adult hematopoietic stem cell transplantation recipients: Clinical experience from a previously endemic population.

Serological Response Following BNT162b2 Anti-Sars-Cov-2 mRNA Vaccination in Hematopoietic Stem Cell Transplantation Patients

Background Allogeneic and autologous hematopoietic stem cell transplantation (HSCT) are potential curative treatments for several hematological malignancies (1). Survival after HSCT has improved over the last decade, but survivors remain at risk for health issues after transplantation. Cardiovascular complications after HSCT are increasingly recognized (2). Cardiovascular diseases may be an important cause of mortality and morbidity in patients after HSCT owing to the toxicities of the cancer therapies; however, the incidence of cardiovascular events (CVEs) in this population has not been completely characterized. The objective of this systematic review is to summarize the evidence on the incidence of CVEs in HSCT recipients. Methods Medline and Embase were searched from inception to December 2020 without language restriction. Two authors independently screened the titles and abstracts. Inclusion criteria were: cohort studies and phase 3 randomized controlled trials that reported CVEs (i.e., heart failure, arrythmias, acute coronary syndrome, and stroke) or cardiovascular death among adults who underwent HSCT for a hematological malignancy. All-cause mortality, relapse-related mortality, and non-relapse-related mortality (NRM) were also collected. Studies in which the follow up period was not started immediately after HSCT were excluded due to the risk of immortal bias. Results Of 8151 nonduplicate articles, 30 studies including 14019 individuals post autologous HSCT, and 22 studies including 31049 individuals post allogeneic HSCT met the inclusion criteria. The cumulative incidence of CVEs in the first 100 days post autologous HSCT was 9% and arrhythmia (i.e., atrial fibrillation) was the most common CVE. In recipients of allogeneic HSCT, the 100-day cumulative incidence of CVEs was 3%, and heart failure (HF) was the most common reported CVE. In recipients of autologous and allogeneic HSCT, cardiovascular death was responsible for 43% and 10% of NRM within 100 days, respectively (Table 1). The incidence of CVEs was 4.96 per 1000-person years (95% CI; 4.21–5.80) in long-term survivors (beyond 100-days) of autologous HSCT, and HF was the most common CVE in this population. In long-term survivors of allogeneic HSCT, the incidence of CVEs was 1.90 per 1000-person years (95% CI: 1.59–2.24). Cardiovascular death was the most frequently reported CVE in long-term survivors of allogeneic HSCT (Table 2). Conclusion CVEs remain a major cause of non relapse morbidity and mortality in recipients of HSCT, especially recipients of autologous HSCT within the first 100 days. Future studies are needed to identify the risk factors for CVEs that are specific to HSCT recipients. Funding Acknowledgement Type of funding sources: None.

ABSTRACTBACKGROUND:Hematopoietic stem cell transplantation (HSCT) recipients requiring intensivecare unit (ICU) admission early after transplantation have a poor prognosis.However, many studies have only focused on allogeneic HSCT recipients.OBJECTIVES:To describe the characteristics of HSCT recipients admitted to the ICUshortly after transplantation and assess differences in 1-year mortalitybetween autologous and allogeneic HSCT recipients.DESIGN AND SETTING:A single-center retrospective cohort study in a cancer center in Brazil.METHODS:We included all consecutive patients who underwent HSCT less than a yearbefore ICU admission between 2009 and 2018. We collected clinical anddemographic data and assessed the 1-year mortality of all patients. Theeffect of allogeneic HSCT compared with autologous HSCT on 1-year mortalityrisk was evaluated in an unadjusted model and an adjusted Cox proportionalhazard model for age and Sequential Organ Failure Assessment (SOFA) atadmission.RESULTS:Of the 942 patients who underwent HSCT during the study period, 83 (8.8%)were included in the study (autologous HSCT = 57 [68.7%], allogeneic HSCT =26 [31.3%]). At 1 year after ICU admission, 21 (36.8%) and 18 (69.2%)patients who underwent autologous and allogeneic HSCT, respectively, haddied. Allogeneic HSCT was associated with increased 1-year mortality(unadjusted hazard ratio, HR = 2.79 [confidence interval, CI, 95%,1.48–5.26]; adjusted HR = 2.62 [CI 95%, 1.29–5.31]).CONCLUSION:Allogeneic HSCT recipients admitted to the ICU had higher short- andlong-term mortality rates than autologous HSCT recipients, even afteradjusting for age and severity at ICU admission.

Invasive Fungal Infections in Recipients of Hematopoietic Stem Cell Transplants: Results From a Single Center Retrospective Analysis

Incidence and Risk Factors of Skin Cancer and Preneoplastic Lesions after Autologous and Allogeneic Hematopoietic Cell Transplantation.

Bacterial bloodstream infections (BSIs) are a serious complication after hematopoietic stem cell transplantation (HSCT), especially when caused by multidrug-resistant (MDR) bacteria. However, data on BSIs post-HSCT from centers in sub-Saharan Africa are limited. This study aims to describe the incidence, etiology, and outcomes of BSIs, including those caused by carbapenem-resistant Enterobacterales (CRE), in both autologous and allogenic HSCT recipients in South Africa. Furthermore, this study examines the incidence and clinical impact of colonization with CRE. A retrospective analysis was performed on clinical data from HSCT recipients, transplanted between January 2018 and December 2023 at Groote Schuur Hospital (GSH) and Red Cross War Memorial Children's Hospital, the academic hospitals of the University of Cape Town. Data were extracted from the transplant unit electronic and paper patient records, Hematology Patient Registry, and the National Health Laboratory Service electronic database. Surveillance cultures were taken upon admission and subsequently repeated weekly for GSH patients. In total, 270 HSCT recipients were included: 145 underwent autologous HSCT, and 124 an allogenic HSCT. The most common indication for autologous HSCT was multiple myeloma (52%), while acute myeloid leukemia was the most frequent for allogenic HSCT (34%). The overall incidence of BSIs was 35%, with a higher rate observed in allogeneic HSCT recipients (48%) compared to autologous HSCT recipients (23%). Gram-negative bacteria were the most common pathogens, and CRE were responsible for 9% of BSIs. Carbapenem-resistant Klebsiella pneumonia spp. was the most common CRE found in BSI and rectal surveillance cultures. Surveillance cultures with CRE were detected in 19% of the HSCT recipients during admission to the transplant unit, with oxacillinase-48 (and variants) the most prevalent carbapenemase. Colonization by CRE was an independent risk factor for developing BSIs. Within 100 days post-HSCT, 25 HSCT recipients (9%) died, of whom nine (36%) had a BSI in the last 7 days of life. Bivariate analysis revealed that BSIs significantly reduced overall survival in both autologous and allogenic HSCT recipients, with a further decrease in survival when the BSI was caused by MDR bacteria. BSIs are a frequent and severe complication among HSCT recipients in South Africa, particularly in those receiving allogenic HSCT. Colonization with CRE significantly increases the risk of BSIs, underscoring the need for vigilant infection control and targeted antimicrobial strategies in this vulnerable population.

Sounding the alarm on deaths from suicide and accidents after hematopoietic stem cell transplantation

The Impact of Pre-Transplant Depression on Outcomes of Allogeneic and Autologous Hematopoietic Stem Cell Transplantation

The purpose of our study was to evaluate the incidence and outcome of invasive fungal infection (IFI) among patients who underwent autologous or allogeneic hematopoietic stem cell transplantation (HSCT) at 11 Italian transplantation centers. This cohort-retrospective study, conducted during 1999-2003, involved HSCT patients admitted to 11 tertiary care centers or university hospitals in Italy, who developed IFIs (proven or probable). Among 3228 patients who underwent HSCT (1249 allogeneic HSCT recipients and 1979 autologous HSCT recipients), IFI occurred in 121 patients (overall incidence, 3.7%). Ninety-one episodes (2.8% of all patients) were due to molds, and 30 (0.9%) were due to yeasts. Ninety-eight episodes (7.8%) occurred among the 1249 allogeneic HSCT recipients, and 23 (1.2%) occurred among the 1979 autologous HSCT recipients. The most frequent etiological agents were Aspergillus species (86 episodes) and Candida species (30 episodes). The overall mortality rate was 5.7% among allogeneic HSCT recipients and 0.4% among autologous HSCT recipients, whereas the attributable mortality rate registered in our population was 65.3% (72.4% for allogeneic HSCT recipients and 34.7% for autologous HSCT recipients). Etiology influenced the patients' outcomes: the attributable mortality rate for aspergillosis was 72.1% (77.2% and 14.3% for allogeneic and autologous HSCT recipients, respectively), and the rate for Candida IFI was 50% (57.1% and 43.8% for allogeneic and autologous HSCT recipients, respectively). IFI represents a common complication for allogeneic HSCT recipients. Aspergillus species is the most frequently detected agent in these patients, and aspergillosis is characterized by a high mortality rate. Conversely, autologous HSCT recipients rarely develop aspergillosis, and the attributable mortality rate is markedly lower. Candidemia was observed less often than aspergillosis among both allogeneic and autologous HSCT recipients; furthermore, there was no difference in either the incidence of or the attributable mortality rate for candidemia among recipients of the 2 transplant types.

To identify patterns of healthcare utilization in allogeneic and autologous hematopoietic stem cell transplantation (HSCT) recipients and evaluate factors associated with high-need and high-cost post-transplantation care. Latent class analysis of a retrospective cohort of long-term allogeneic (n = 436) and autologous (n = 888) HSCT survivors within the Truven MarketScan database (2009-2014). We assessed factors associated with the latent classes by comparing post-transplantation healthcare utilization including inpatient admissions and length of stay, emergency room visits, specialist visits, and primary care provider visits. Four utilization classes were identified in allogeneic and autologous HSCT recipients: (i) outpatient specialist care dominant (51.8% and 57.3%), (ii) outpatient primary care dominant (10.3% and 25.7%), (iii) outpatient/inpatient balanced (20.6% and 13.5%), and (iv) inpatient dominant (17.2% and 3.5%). Mean monthly healthcare expenditures in the inpatient dominant utilization class were $41,097 and $25,556 for allogeneic and autologous survivors, respectively, which were two to five times higher compared with other classes during the 2-year post-transplantation period. Factors associated with the high utilization class were transfusion (OR = 1.87, 95% CI 1.06-3.30) and 100-day post-transplant graft-versus-host-disease (OR = 1.76, 95% CI 1.05-2.94) in allogeneic HSCT; higher baseline Charlson comorbidity index (OR = 1.45, 95% CI 1.19-1.76) in autologous HSCT. Based on distinct patterns of healthcare utilization following HSCT, we identified factors associated with higher resource utilization and greater healthcare related expenditures. Earlier identification of high-cost and high-need HSCT long-term survivors could pave the way for clinicians to offer more continuous engagement in survivorship care delivery.

Impact Of Systemic Antibiotic Prophylaxis In Hematopoietic Stem Cell Transplantation Recipients. A Meta-Analysis Of Randomized Controlled Trials

High Incidence of Invasive Fungal Infections in Adult Patients Undergoing Hematopoietic Stem Cell Transplantation.

Clinical Characteristics and Outcomes of COVID-19 in Pediatric and Early Adolescent and Young Adult Hematopoietic Stem Cell Transplant Recipients: A Cohort Study

BackgroundClostridioides difficile infection (CDI) is increasingly common among hematopoietic stem cell transplantation (HSCT) recipients and efforts to define CDI risk have shown variable results. The primary objective of this study was to further characterize CDI incidence and risk factors in HSCT recipients.MethodsAll allogeneic and autologous HSCT recipients at Loyola University Chicago between January 2011 and May 2017 were retrospectively reviewed for development of CDI within 6 months prior to 2 years following HSCT. Collected data include comorbid conditions, statin or proton pump inhibitor (PPI), and antimicrobial use. HSCT baseline information was also obtained and include underlying malignancy, prior chemotherapy, graft type, conditioning regimen consisting of total body irradiation (TBI) use, and donor source (matched related or unrelated and umbilical cord blood). Among those with diagnosed CDI, data pertaining to CDI severity, treatment, and recurrence was collected. Logistic regression analyses were performed to estimate odds ratios for factors associated with development of CDI.ResultsSix hundred eighty-nine patients met our inclusion criteria. Of these, 367 (53%) underwent autologous HSCT and 322 (47%) allogeneic HSCT. Among all patients, 132 (19.1%) had CDI of which 26 (19.7%) had recurrence within 60 days. In univariable analysis, any type of leukemia was associated with increased odds of CDI compared with lymphoma (OR = 2.44, 95% CI: 1.49- 4.00, P < 0.01) as was allogeneic HSCT compared with autologous (OR = 2.51, 95% CI: 1.63–3.88, P < 0.01 for matched and OR = 3.96, 95% CI: 2.31–6.79, P < 0.01 for cord blood) and use of TBI (OR = 1.63, 95% CI: 1.10 – 2.40, P < 0.05). Exposure to any cephalosporin or intravenous vancomycin within 100 days of HSCT was associated with CDI (OR = 1.55, 95% CI: 1.03–2.32, P < 0.05 and OR = 1.75, 95% CI: 1.19–2.58, P < 0.01 respectively). No significant differences in the odds of developing CDI were identified by patient comorbidities, statin or PPI use.ConclusionIn our population there was a 19% incidence of CDI. Underlying leukemia, TBI exposure, and allogeneic HSCT appear to be risk factors for CDI and further research is needed to evaluate whether exposure to cephalosporin or vancomycin may be modifiable risk factors.DisclosuresAll authors: No reported disclosures.

Severe sepsis requires timely management and has high mortality if care is delayed. Hematopoietic stem cell transplant recipients are more likely to be immunocompromised and are predisposed to serious infections. Reports of outcomes of severe sepsis in this population are limited to data from single, tertiary care centers, and national outcomes data are missing. Retrospective analysis of an administrative database. Twenty percent of community hospitals in United States, excluding federal hospitals. Patients with severe sepsis. None. We used International Classification of Diseases, 9th Edition, Clinical Modification codes indicating the presence of sepsis and organ system failure to identify hospitalizations for severe sepsis between 2000 and 2008. We also used International Classification of Diseases, 9th Edition, Clinical Modification codes to identify hematopoietic stem cell transplant recipients. We compared outcomes of hematopoietic stem cell transplant recipients with severe sepsis during engraftment and subsequent admissions with a non-hematopoietic stem cell transplant cohort and excluded solid-organ transplantation from this cohort. We used mixed effect, multivariate logistic regression modeling with propensity score adjustment to examine factors associated with mortality of severe sepsis in hematopoietic stem cell transplant recipients. A total of 21,898 hematopoietic stem cell transplant recipients with severe sepsis were identified. The frequency of severe sepsis in hematopoietic stem cell transplant recipients was five times higher when compared with the non-hematopoietic stem cell transplant cohort. The unadjusted mortality was 32.9% in non-hematopoietic stem cell transplant cohort, which was similar to autologous hematopoietic stem cell transplant recipients (30.1%) and those who did not develop graft-versus-host disease (35%). Mortality was significantly higher in allogeneic transplants (55.1%, p < 0.001) and in those who developed graft-versus-host disease (47.9%, p < 0.001). After adjustment, during engraftment admission, the odds of in-hospital mortality in allogeneic hematopoietic stem cell transplant (odds ratio, 3.81; 95% CI, 2.39-6.07) and autologous hematopoietic stem cell transplant (odds ratio, 1.28; 95% CI, 1.06-1.53) recipients was significantly higher than non-hematopoietic stem cell transplant patients. Similarly, in subsequent admissions, hematopoietic stem cell transplant recipients with graft-versus-host disease (odds ratio, 2.14; 95% CI, 1.88-2.45) and without graft-versus-host disease (odds ratio, 1.35; 95% CI, 1.19-1.54) had significantly higher odds of mortality than non-hematopoietic stem cell transplant patients. Among patients with hematopoietic stem cell transplant, persons with autologous hematopoietic stem cell transplant and those without graft-versus-host disease fared better as compared with their allogeneic and graft-versus-host disease counterparts. Hematopoietic stem cell transplant recipients are more likely to develop severe sepsis and die following a severe sepsis episode than nontransplant patients. Autologous hematopoietic stem cell transplant recipients and those who do not develop graft-versus-host disease have significantly better outcomes than allogeneic and graft-versus-host disease patients.