Late infectious complications in hematopoietic cell transplantation survivors: a population-based study
Open Access
- 30 March 2020
- journal article
- research article
- Published by American Society of Hematology in Blood Advances
- Vol. 4 (7), 1232-1241
- https://doi.org/10.1182/bloodadvances.2020001470
Abstract
Few studies have compared the incidence of infections occurring ≥2 years after hematopoietic cell transplant (HCT) with other cancer patients and the general population. In this study, ≥2-year HCT survivors who were Washington residents treated from 1992 through 2009 (n = 1792; median age, 46 years; 52% allogeneic; 90% hematologic malignancies) were matched to individuals from the state cancer registry (n = 5455, non-HCT) and driver’s license files (n = 16 340; Department of Licensing [DOL]). Based on hospital and death registry codes, incidence rate ratios (IRRs; 95% confidence interval [CI]) of infections by organism type and organ system were estimated using Poisson regression. With 7-year median follow-up, the incidence rate (per 1000 person-years) of all infections was 65.4 for HCT survivors vs 39.6 for the non-HCT group (IRR, 1.6; 95% CI, 1.3-1.9) and 7.2 for DOL (IRR, 10.0; 95% CI, 8.3-12.1). Bacterial and fungal infections were each 70% more common in HCT vs non-HCT cancer survivors (IRR, 1.7; P < .01), whereas the risk for viral infection was lower (IRR, 1.4; P = .07). Among potentially vaccine-preventable organisms, the IRR was 3.0 (95% CI, 2.1-4.3) vs the non-HCT group. Although the incidences of all infections decreased with time, the relative risk in almost all categories remained significantly increased in ≥5-year HCT survivors vs other groups. Risk factors for late infection included history of relapse and for some infections, history of chronic graft-versus-host disease. Providers caring for HCT survivors should maintain vigilance for infections and ensure adherence to antimicrobial prophylaxis and vaccination guidelines.This publication has 36 references indexed in Scilit:
- Recommended Screening and Preventive Practices for Long-Term Survivors after Hematopoietic Cell TransplantationTransplantation and Cellular Therapy, 2012
- Challenges to Preventing Infectious Complications, Decreasing Re-hospitalizations, and Reducing Cost Burden in Long-Term Survivors After Allogeneic Hematopoietic Stem Cell TransplantationSeminars in Hematology, 2012
- Life Expectancy in Patients Surviving More Than 5 Years After Hematopoietic Cell TransplantationJournal of Clinical Oncology, 2010
- Guidelines for Preventing Infectious Complications among Hematopoietic Cell Transplantation Recipients: A Global PerspectiveTransplantation and Cellular Therapy, 2009
- Vaccination of hematopoietic cell transplant recipientsBone Marrow Transplantation, 2009
- Evaluation of NIH consensus criteria for classification of late acute and chronic GVHDBlood, 2009
- Risk factors for fatal infectious complications developing late after allogeneic stem cell transplantationBone Marrow Transplantation, 2007
- ICD-10 codes are a valid tool for identification of pneumonia in hospitalized patients aged ⩾65 yearsEpidemiology and Infection, 2007
- Guidelines for preventing opportunistic infections among hematopoietic stem cell transplant recipients: Recommendations of Centers for Disease Control, the Infectious Disease Society of America, and the American Society of Blood and Marrow TransplantationTransplantation and Cellular Therapy, 2000
- Robust inference for multivariate survival dataStatistics in Medicine, 1993