Abstract 906P
Background
Patients with acute graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (HSCT) are at high risk of infectious complications (IC). However, the number of published studies on the epidemiology of infections in GVHD is limited.
Methods
Single center retrospective study included 65 adult patients with acute GVHD after allo-HSCT from 2014 to 2017. An analysis of IC was considered within one year from the onset of aGVHD and was censored by the date of the onset of chronic GVHD or relapse underling disease. The median time of aGVHD onset was 39 days (16-114) after allo-HSCT, the median follow-up time was 22.2 months (6 days - 63.8 months).
Results
IC developed in 86% of patients with aGVHD. The incidence of bacterial infections (BI) was 27.7% (n=18). The median time of BI onset was 35 days (0-276). The main pathogens were Kl. pneumoniae (41%), Pseudomonas aeruginosa (23%), Streptococcus viridians group (12%). Risk factors were 3-4 grade aGVHD (p=0.004), the use of ATG for GVHD prophylaxis (p=0.0001), grade 4 neutropenia (p=0.001) and grade 4 lymphopenia (p=0.007), lack of response to first line immunosuppressive therapy for 28 days (p=0.0001). The incidence of viral infections (VI) was 66.2% (n=43). The median time of VI onset was 17 days (0-88). The etiology of VI were represented by: CMV - 64%, BK / JC - 20%, EBV - 9%. The main risk factor was the CMV-positive status of donor-recipient pair before HSCT (p=0.025). The incidence of invasive fungal disease (IFD) was 6.2% (n=4), and pulmonary aspergillosis was diagnosed in all cases. The median time of IFD onset was 11 days (3-38). Risk factors for IFD were grade 4 neutropenia (p=0.0001) and grade 4 lymphopenia (p=0.004). 2-year overall survival (OS) from the onset of aGVHD was 61.5%. Grades 3-4 of aGVHD (p=0.02) and sepsis (p=0.0001) were factors associated with significantly decreased the OS rate.
Conclusions
Infectious complications developed in 86% of patients with aGVHD. The highest incidence was VI, less – bacterial, and also an IFD – 6,2%. The main risk factors for BI and IFD were grade 4 neutropenia and lymphopenia, for VI - CMV status of donor-recipient pair. VI and IFD did not influence on the 2-year OS of patients with aGVHD. Among IC sepsis is the main cause of mortality in patients with aGVHD.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.