Increased overall and bacterial infections following myeloablative allogeneic HCT for patients with AML in CR1

Celalettin Ustun; Soyoung Kim; Min Chen; Amer M. Beitinjaneh; Valerie I. Brown; Parastoo B. Dahi; Andrew Daly; Miguel Angel Diaz; Cesar O. Freytes; Siddhartha Ganguly; Shahrukh Hashmi; Gerhard C. Hildebrandt; Hillard M. Lazarus; Taiga Nishihori; Richard F. Olsson; Kristin M. Page; Genovefa Papanicolaou; Ayman Saad; Sachiko Seo; Basem M. William; John R. Wingard; Baldeep Wirk; Jean A. Yared; Miguel Angel Perales; Jeffery J. Auletta; Krishna V. Komanduri; Caroline A. Lindemans; Marcie L. Riches

doi:10.1182/bloodadvances.2019000226

Increased overall and bacterial infections following myeloablative allogeneic HCT for patients with AML in CR1

Celalettin Ustun, Soyoung Kim, Min Chen, Amer M. Beitinjaneh, Valerie I. Brown, Parastoo B. Dahi, Andrew Daly, Miguel Angel Diaz, Cesar O. Freytes, Siddhartha Ganguly, Shahrukh Hashmi, Gerhard C. Hildebrandt, Hillard M. Lazarus, Taiga Nishihori, Richard F. Olsson, Kristin M. Page, Genovefa Papanicolaou, Ayman Saad, Sachiko Seo, Basem M. WilliamJohn R. Wingard, Baldeep Wirk, Jean A. Yared, Miguel Angel Perales, Jeffery J. Auletta, Krishna V. Komanduri, Caroline A. Lindemans, Marcie L. Riches

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

Abstract

Presumably, reduced-intensity/nonmyeloablative conditioning (RIC/NMA) for allogeneic hematopoietic cell transplantation (alloHCT) results in reduced infections compared with myeloablative conditioning (MAC) regimens; however, published evidence is limited. In this Center for International Blood and Marrow Transplant Research study, 1755 patients (aged ≥40 years) with acute myeloid leukemia in first complete remission were evaluated for infections occurring within 100 days after T-cell replete alloHCT. Patients receiving RIC/NMA (n = 777) compared with those receiving MAC (n = 978) were older and underwent transplantation more recently; however, the groups were similar regarding Karnofsky performance score, HCT-comorbidity index, and cytogenetic risk. One or more infections occurred in 1045 (59.5%) patients (MAC, 595 [61%]; RIC/NMA, 450 [58%]; P = .21) by day 100. The median time to initial infection after MAC conditioning occurred earlier (MAC, 15 days [range, <1-99 days]; RIC/NMA, 21 days [range, <1-100 days]; P < .001). Patients receivingMAC were more likely to experience at least 1 bacterial infection by day 100 (MAC, 46% [95% confidence interval (CI), 43-49]; RIC/NMA, 37% [95% CI, 34-41]; P = .0004), whereas at least a single viral infection was more prevalent in the RIC/NMA cohort (MAC, 34% [95% CI, 31-37]; RIC/NMA, 39% [95%CI, 36-42]; P5.046). MAC remained a risk factor for bacterial infections in multivariable analysis (relative risk, 1.44; 95% CI, 1.23-1.67; P < .0001). Moreover, the rate of any infection per patient-days at risk in the first 100 days (infection density) after alloHCTwas greater for the MAC cohort (1.21; 95% CI, 1.11-1.32; P < .0001). RIC/NMA was associated with reduced infections, especially bacterial infections, in the first 100 days after alloHCT.

Original language	English
Pages (from-to)	2525-2536
Number of pages	12
Journal	Blood advances
Volume	3
Issue number	17
DOIs	https://doi.org/10.1182/bloodadvances.2019000226
State	Published - Sep 10 2019

Bibliographical note

Funding Information:
The CIBMTR is supported primarily by Public Health Service Grant/Cooperative Agreement 5U24CA076518 from the National Cancer Institute, the National Heart, Lung, and Blood Institute, and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health; Grant/Cooperative Agreement 4U10HL069294 from the National Institues of Health, National Heart, Lung, and Blood Institute and National Cancer Institute; contract HHSH250201200016C with the Health Resources and Services Administration (Department of Health and Human Services); and 2 grants (N00014-17-1-2388 and N0014-17-1-2850) from the Office of Naval Research. The CIBMTR is also supported by grants from Actinium Pharmaceuticals, Inc., Amgen, Inc., Amneal Biosciences, Angiocrine Bioscience, Inc., an anonymous donation to the Medical College of Wisconsin, Astellas Pharma US, Atara Biotherapeutics, Inc., Be the Match Foundation, bluebird bio, Inc., Bristol-Myers Squibb Oncology, Celgene Corporation, Cerus Corporation, Chimerix, Inc., Fred Hutchinson Cancer Research Center, Gamida Cell Ltd., Gilead Sciences, Inc., HistoGenetics, Inc., Immucor, Incyte Corporation, Janssen Scientific Affairs, LLC, Jazz Pharmaceuticals, Inc., Juno Therapeutics, Karyopharm Therapeutics, Inc., Kite Pharma, Inc., medac GmbH, MedImmune, The Medical College of Wisconsin, Mediware, Merck & Co., Inc., Mesoblast, MesoScale Diagnostics, Inc., Millennium, the Takeda Oncology Co., Miltenyi Biotec, National Marrow Donor Program, Neovii Biotech NA, Inc., Novartis Pharmaceuticals Corporation, Otsuka Pharmaceutical Co, Ltd.-Japan, PCORI, Pfizer Inc., Pharmacyclics, LLC, PIRCHE AG, Sanofi Genzyme, Seattle Genetics, Shire, Spectrum Pharmaceuticals, Inc., St. Baldrick's Foundation, Sunesis Pharmaceuticals, Inc., Swedish Orphan Biovitrum, Inc., Takeda Oncology, Telomere Diagnostics, Inc., and the University of Minnesota. The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, the Department of the Navy, the Department of Defense, the Health Resources and Services Administration, or any other agency of the US Government.

Funding Information:
Acknowledgments The CIBMTR is supported primarily by Public Health Service Grant/ Cooperative Agreement 5U24CA076518 from the National Cancer Institute, the National Heart, Lung, and Blood Institute, and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health; Grant/Cooperative Agreement 4U10HL069294 from the National Institues of Health, National Heart, Lung, and Blood Institute and National Cancer Institute; contract HHSH250201200016C with the Health Resources and Services Administration (Department of Health and Human Services); and 2 grants (N00014-17-1-2388 and N0014-17-1-2850) from the Office of Naval Research. The CIBMTR is also supported by grants from Actinium Pharmaceuticals, Inc., Amgen, Inc., Amneal Biosciences, Angiocrine Bioscience, Inc., an anonymous donation to the Medical College of Wisconsin, Astellas Pharma US, Atara Biotherapeutics, Inc., Be the Match Foundation, bluebird bio, Inc., Bristol-Myers Squibb Oncology, Celgene Corporation, Cerus Corporation, Chimerix, Inc., Fred Hutchinson Cancer Research Center, Gamida Cell Ltd., Gilead Sciences, Inc., HistoGenetics, Inc., Immucor, Incyte Corporation, Janssen Scientific Affairs, LLC, Jazz Pharmaceuticals, Inc., Juno Therapeutics, Karyopharm Therapeutics, Inc., Kite Pharma, Inc., medac GmbH, MedImmune, The Medical College of Wisconsin, Mediware, Merck & Co., Inc., Mesoblast, MesoScale Diagnostics, Inc., Millennium, the Takeda Oncology Co., Miltenyi Biotec, National Marrow Donor Program, Neovii Biotech NA, Inc., Novartis Pharmaceuticals Corporation, Otsuka Pharmaceutical Co, Ltd.–Japan, PCORI, Pfizer Inc., Pharmacyclics, LLC, PIRCHE

Publisher Copyright:
© 2019 by The American Society of Hematology.

ASJC Scopus subject areas

Hematology

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10.1182/bloodadvances.2019000226

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Ustun, C., Kim, S., Chen, M., Beitinjaneh, A. M., Brown, V. I., Dahi, P. B., Daly, A., Diaz, M. A., Freytes, C. O., Ganguly, S., Hashmi, S., Hildebrandt, G. C., Lazarus, H. M., Nishihori, T., Olsson, R. F., Page, K. M., Papanicolaou, G., Saad, A., Seo, S., ... Riches, M. L. (2019). Increased overall and bacterial infections following myeloablative allogeneic HCT for patients with AML in CR1. Blood advances, 3(17), 2525-2536. https://doi.org/10.1182/bloodadvances.2019000226

@article{ac95c9f92ef44e3b9f1319b18bf23462,

title = "Increased overall and bacterial infections following myeloablative allogeneic HCT for patients with AML in CR1",

abstract = "Presumably, reduced-intensity/nonmyeloablative conditioning (RIC/NMA) for allogeneic hematopoietic cell transplantation (alloHCT) results in reduced infections compared with myeloablative conditioning (MAC) regimens; however, published evidence is limited. In this Center for International Blood and Marrow Transplant Research study, 1755 patients (aged ≥40 years) with acute myeloid leukemia in first complete remission were evaluated for infections occurring within 100 days after T-cell replete alloHCT. Patients receiving RIC/NMA (n = 777) compared with those receiving MAC (n = 978) were older and underwent transplantation more recently; however, the groups were similar regarding Karnofsky performance score, HCT-comorbidity index, and cytogenetic risk. One or more infections occurred in 1045 (59.5%) patients (MAC, 595 [61%]; RIC/NMA, 450 [58%]; P = .21) by day 100. The median time to initial infection after MAC conditioning occurred earlier (MAC, 15 days [range, <1-99 days]; RIC/NMA, 21 days [range, <1-100 days]; P < .001). Patients receivingMAC were more likely to experience at least 1 bacterial infection by day 100 (MAC, 46% [95% confidence interval (CI), 43-49]; RIC/NMA, 37% [95% CI, 34-41]; P = .0004), whereas at least a single viral infection was more prevalent in the RIC/NMA cohort (MAC, 34% [95% CI, 31-37]; RIC/NMA, 39% [95%CI, 36-42]; P5.046). MAC remained a risk factor for bacterial infections in multivariable analysis (relative risk, 1.44; 95% CI, 1.23-1.67; P < .0001). Moreover, the rate of any infection per patient-days at risk in the first 100 days (infection density) after alloHCTwas greater for the MAC cohort (1.21; 95% CI, 1.11-1.32; P < .0001). RIC/NMA was associated with reduced infections, especially bacterial infections, in the first 100 days after alloHCT.",

author = "Celalettin Ustun and Soyoung Kim and Min Chen and Beitinjaneh, {Amer M.} and Brown, {Valerie I.} and Dahi, {Parastoo B.} and Andrew Daly and Diaz, {Miguel Angel} and Freytes, {Cesar O.} and Siddhartha Ganguly and Shahrukh Hashmi and Hildebrandt, {Gerhard C.} and Lazarus, {Hillard M.} and Taiga Nishihori and Olsson, {Richard F.} and Page, {Kristin M.} and Genovefa Papanicolaou and Ayman Saad and Sachiko Seo and William, {Basem M.} and Wingard, {John R.} and Baldeep Wirk and Yared, {Jean A.} and Perales, {Miguel Angel} and Auletta, {Jeffery J.} and Komanduri, {Krishna V.} and Lindemans, {Caroline A.} and Riches, {Marcie L.}",

note = "Funding Information: The CIBMTR is supported primarily by Public Health Service Grant/Cooperative Agreement 5U24CA076518 from the National Cancer Institute, the National Heart, Lung, and Blood Institute, and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health; Grant/Cooperative Agreement 4U10HL069294 from the National Institues of Health, National Heart, Lung, and Blood Institute and National Cancer Institute; contract HHSH250201200016C with the Health Resources and Services Administration (Department of Health and Human Services); and 2 grants (N00014-17-1-2388 and N0014-17-1-2850) from the Office of Naval Research. The CIBMTR is also supported by grants from Actinium Pharmaceuticals, Inc., Amgen, Inc., Amneal Biosciences, Angiocrine Bioscience, Inc., an anonymous donation to the Medical College of Wisconsin, Astellas Pharma US, Atara Biotherapeutics, Inc., Be the Match Foundation, bluebird bio, Inc., Bristol-Myers Squibb Oncology, Celgene Corporation, Cerus Corporation, Chimerix, Inc., Fred Hutchinson Cancer Research Center, Gamida Cell Ltd., Gilead Sciences, Inc., HistoGenetics, Inc., Immucor, Incyte Corporation, Janssen Scientific Affairs, LLC, Jazz Pharmaceuticals, Inc., Juno Therapeutics, Karyopharm Therapeutics, Inc., Kite Pharma, Inc., medac GmbH, MedImmune, The Medical College of Wisconsin, Mediware, Merck & Co., Inc., Mesoblast, MesoScale Diagnostics, Inc., Millennium, the Takeda Oncology Co., Miltenyi Biotec, National Marrow Donor Program, Neovii Biotech NA, Inc., Novartis Pharmaceuticals Corporation, Otsuka Pharmaceutical Co, Ltd.-Japan, PCORI, Pfizer Inc., Pharmacyclics, LLC, PIRCHE AG, Sanofi Genzyme, Seattle Genetics, Shire, Spectrum Pharmaceuticals, Inc., St. Baldrick's Foundation, Sunesis Pharmaceuticals, Inc., Swedish Orphan Biovitrum, Inc., Takeda Oncology, Telomere Diagnostics, Inc., and the University of Minnesota. The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, the Department of the Navy, the Department of Defense, the Health Resources and Services Administration, or any other agency of the US Government. Funding Information: Acknowledgments The CIBMTR is supported primarily by Public Health Service Grant/ Cooperative Agreement 5U24CA076518 from the National Cancer Institute, the National Heart, Lung, and Blood Institute, and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health; Grant/Cooperative Agreement 4U10HL069294 from the National Institues of Health, National Heart, Lung, and Blood Institute and National Cancer Institute; contract HHSH250201200016C with the Health Resources and Services Administration (Department of Health and Human Services); and 2 grants (N00014-17-1-2388 and N0014-17-1-2850) from the Office of Naval Research. The CIBMTR is also supported by grants from Actinium Pharmaceuticals, Inc., Amgen, Inc., Amneal Biosciences, Angiocrine Bioscience, Inc., an anonymous donation to the Medical College of Wisconsin, Astellas Pharma US, Atara Biotherapeutics, Inc., Be the Match Foundation, bluebird bio, Inc., Bristol-Myers Squibb Oncology, Celgene Corporation, Cerus Corporation, Chimerix, Inc., Fred Hutchinson Cancer Research Center, Gamida Cell Ltd., Gilead Sciences, Inc., HistoGenetics, Inc., Immucor, Incyte Corporation, Janssen Scientific Affairs, LLC, Jazz Pharmaceuticals, Inc., Juno Therapeutics, Karyopharm Therapeutics, Inc., Kite Pharma, Inc., medac GmbH, MedImmune, The Medical College of Wisconsin, Mediware, Merck & Co., Inc., Mesoblast, MesoScale Diagnostics, Inc., Millennium, the Takeda Oncology Co., Miltenyi Biotec, National Marrow Donor Program, Neovii Biotech NA, Inc., Novartis Pharmaceuticals Corporation, Otsuka Pharmaceutical Co, Ltd.–Japan, PCORI, Pfizer Inc., Pharmacyclics, LLC, PIRCHE Publisher Copyright: {\textcopyright} 2019 by The American Society of Hematology.",

year = "2019",

month = sep,

day = "10",

doi = "10.1182/bloodadvances.2019000226",

language = "English",

volume = "3",

pages = "2525--2536",

number = "17",

}

Ustun, C, Kim, S, Chen, M, Beitinjaneh, AM, Brown, VI, Dahi, PB, Daly, A, Diaz, MA, Freytes, CO, Ganguly, S, Hashmi, S, Hildebrandt, GC, Lazarus, HM, Nishihori, T, Olsson, RF, Page, KM, Papanicolaou, G, Saad, A, Seo, S, William, BM, Wingard, JR, Wirk, B, Yared, JA, Perales, MA, Auletta, JJ, Komanduri, KV, Lindemans, CA & Riches, ML 2019, 'Increased overall and bacterial infections following myeloablative allogeneic HCT for patients with AML in CR1', Blood advances, vol. 3, no. 17, pp. 2525-2536. https://doi.org/10.1182/bloodadvances.2019000226

TY - JOUR

T1 - Increased overall and bacterial infections following myeloablative allogeneic HCT for patients with AML in CR1

AU - Ustun, Celalettin

AU - Kim, Soyoung

AU - Chen, Min

AU - Beitinjaneh, Amer M.

AU - Brown, Valerie I.

AU - Dahi, Parastoo B.

AU - Daly, Andrew

AU - Diaz, Miguel Angel

AU - Freytes, Cesar O.

AU - Ganguly, Siddhartha

AU - Hashmi, Shahrukh

AU - Hildebrandt, Gerhard C.

AU - Lazarus, Hillard M.

AU - Nishihori, Taiga

AU - Olsson, Richard F.

AU - Page, Kristin M.

AU - Papanicolaou, Genovefa

AU - Saad, Ayman

AU - Seo, Sachiko

AU - William, Basem M.

AU - Wingard, John R.

AU - Wirk, Baldeep

AU - Yared, Jean A.

AU - Perales, Miguel Angel

AU - Auletta, Jeffery J.

AU - Komanduri, Krishna V.

AU - Lindemans, Caroline A.

AU - Riches, Marcie L.

N1 - Funding Information: The CIBMTR is supported primarily by Public Health Service Grant/Cooperative Agreement 5U24CA076518 from the National Cancer Institute, the National Heart, Lung, and Blood Institute, and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health; Grant/Cooperative Agreement 4U10HL069294 from the National Institues of Health, National Heart, Lung, and Blood Institute and National Cancer Institute; contract HHSH250201200016C with the Health Resources and Services Administration (Department of Health and Human Services); and 2 grants (N00014-17-1-2388 and N0014-17-1-2850) from the Office of Naval Research. The CIBMTR is also supported by grants from Actinium Pharmaceuticals, Inc., Amgen, Inc., Amneal Biosciences, Angiocrine Bioscience, Inc., an anonymous donation to the Medical College of Wisconsin, Astellas Pharma US, Atara Biotherapeutics, Inc., Be the Match Foundation, bluebird bio, Inc., Bristol-Myers Squibb Oncology, Celgene Corporation, Cerus Corporation, Chimerix, Inc., Fred Hutchinson Cancer Research Center, Gamida Cell Ltd., Gilead Sciences, Inc., HistoGenetics, Inc., Immucor, Incyte Corporation, Janssen Scientific Affairs, LLC, Jazz Pharmaceuticals, Inc., Juno Therapeutics, Karyopharm Therapeutics, Inc., Kite Pharma, Inc., medac GmbH, MedImmune, The Medical College of Wisconsin, Mediware, Merck & Co., Inc., Mesoblast, MesoScale Diagnostics, Inc., Millennium, the Takeda Oncology Co., Miltenyi Biotec, National Marrow Donor Program, Neovii Biotech NA, Inc., Novartis Pharmaceuticals Corporation, Otsuka Pharmaceutical Co, Ltd.-Japan, PCORI, Pfizer Inc., Pharmacyclics, LLC, PIRCHE AG, Sanofi Genzyme, Seattle Genetics, Shire, Spectrum Pharmaceuticals, Inc., St. Baldrick's Foundation, Sunesis Pharmaceuticals, Inc., Swedish Orphan Biovitrum, Inc., Takeda Oncology, Telomere Diagnostics, Inc., and the University of Minnesota. The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, the Department of the Navy, the Department of Defense, the Health Resources and Services Administration, or any other agency of the US Government. Funding Information: Acknowledgments The CIBMTR is supported primarily by Public Health Service Grant/ Cooperative Agreement 5U24CA076518 from the National Cancer Institute, the National Heart, Lung, and Blood Institute, and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health; Grant/Cooperative Agreement 4U10HL069294 from the National Institues of Health, National Heart, Lung, and Blood Institute and National Cancer Institute; contract HHSH250201200016C with the Health Resources and Services Administration (Department of Health and Human Services); and 2 grants (N00014-17-1-2388 and N0014-17-1-2850) from the Office of Naval Research. The CIBMTR is also supported by grants from Actinium Pharmaceuticals, Inc., Amgen, Inc., Amneal Biosciences, Angiocrine Bioscience, Inc., an anonymous donation to the Medical College of Wisconsin, Astellas Pharma US, Atara Biotherapeutics, Inc., Be the Match Foundation, bluebird bio, Inc., Bristol-Myers Squibb Oncology, Celgene Corporation, Cerus Corporation, Chimerix, Inc., Fred Hutchinson Cancer Research Center, Gamida Cell Ltd., Gilead Sciences, Inc., HistoGenetics, Inc., Immucor, Incyte Corporation, Janssen Scientific Affairs, LLC, Jazz Pharmaceuticals, Inc., Juno Therapeutics, Karyopharm Therapeutics, Inc., Kite Pharma, Inc., medac GmbH, MedImmune, The Medical College of Wisconsin, Mediware, Merck & Co., Inc., Mesoblast, MesoScale Diagnostics, Inc., Millennium, the Takeda Oncology Co., Miltenyi Biotec, National Marrow Donor Program, Neovii Biotech NA, Inc., Novartis Pharmaceuticals Corporation, Otsuka Pharmaceutical Co, Ltd.–Japan, PCORI, Pfizer Inc., Pharmacyclics, LLC, PIRCHE Publisher Copyright: © 2019 by The American Society of Hematology.

PY - 2019/9/10

Y1 - 2019/9/10

N2 - Presumably, reduced-intensity/nonmyeloablative conditioning (RIC/NMA) for allogeneic hematopoietic cell transplantation (alloHCT) results in reduced infections compared with myeloablative conditioning (MAC) regimens; however, published evidence is limited. In this Center for International Blood and Marrow Transplant Research study, 1755 patients (aged ≥40 years) with acute myeloid leukemia in first complete remission were evaluated for infections occurring within 100 days after T-cell replete alloHCT. Patients receiving RIC/NMA (n = 777) compared with those receiving MAC (n = 978) were older and underwent transplantation more recently; however, the groups were similar regarding Karnofsky performance score, HCT-comorbidity index, and cytogenetic risk. One or more infections occurred in 1045 (59.5%) patients (MAC, 595 [61%]; RIC/NMA, 450 [58%]; P = .21) by day 100. The median time to initial infection after MAC conditioning occurred earlier (MAC, 15 days [range, <1-99 days]; RIC/NMA, 21 days [range, <1-100 days]; P < .001). Patients receivingMAC were more likely to experience at least 1 bacterial infection by day 100 (MAC, 46% [95% confidence interval (CI), 43-49]; RIC/NMA, 37% [95% CI, 34-41]; P = .0004), whereas at least a single viral infection was more prevalent in the RIC/NMA cohort (MAC, 34% [95% CI, 31-37]; RIC/NMA, 39% [95%CI, 36-42]; P5.046). MAC remained a risk factor for bacterial infections in multivariable analysis (relative risk, 1.44; 95% CI, 1.23-1.67; P < .0001). Moreover, the rate of any infection per patient-days at risk in the first 100 days (infection density) after alloHCTwas greater for the MAC cohort (1.21; 95% CI, 1.11-1.32; P < .0001). RIC/NMA was associated with reduced infections, especially bacterial infections, in the first 100 days after alloHCT.

AB - Presumably, reduced-intensity/nonmyeloablative conditioning (RIC/NMA) for allogeneic hematopoietic cell transplantation (alloHCT) results in reduced infections compared with myeloablative conditioning (MAC) regimens; however, published evidence is limited. In this Center for International Blood and Marrow Transplant Research study, 1755 patients (aged ≥40 years) with acute myeloid leukemia in first complete remission were evaluated for infections occurring within 100 days after T-cell replete alloHCT. Patients receiving RIC/NMA (n = 777) compared with those receiving MAC (n = 978) were older and underwent transplantation more recently; however, the groups were similar regarding Karnofsky performance score, HCT-comorbidity index, and cytogenetic risk. One or more infections occurred in 1045 (59.5%) patients (MAC, 595 [61%]; RIC/NMA, 450 [58%]; P = .21) by day 100. The median time to initial infection after MAC conditioning occurred earlier (MAC, 15 days [range, <1-99 days]; RIC/NMA, 21 days [range, <1-100 days]; P < .001). Patients receivingMAC were more likely to experience at least 1 bacterial infection by day 100 (MAC, 46% [95% confidence interval (CI), 43-49]; RIC/NMA, 37% [95% CI, 34-41]; P = .0004), whereas at least a single viral infection was more prevalent in the RIC/NMA cohort (MAC, 34% [95% CI, 31-37]; RIC/NMA, 39% [95%CI, 36-42]; P5.046). MAC remained a risk factor for bacterial infections in multivariable analysis (relative risk, 1.44; 95% CI, 1.23-1.67; P < .0001). Moreover, the rate of any infection per patient-days at risk in the first 100 days (infection density) after alloHCTwas greater for the MAC cohort (1.21; 95% CI, 1.11-1.32; P < .0001). RIC/NMA was associated with reduced infections, especially bacterial infections, in the first 100 days after alloHCT.

UR - http://www.scopus.com/inward/record.url?scp=85072110353&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85072110353&partnerID=8YFLogxK

U2 - 10.1182/bloodadvances.2019000226

DO - 10.1182/bloodadvances.2019000226

M3 - Article

C2 - 31471322

AN - SCOPUS:85072110353

VL - 3

SP - 2525

EP - 2536

IS - 17

ER -

Increased overall and bacterial infections following myeloablative allogeneic HCT for patients with AML in CR1

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