Distinct Clinical Features of Infectious Complications in Adult T Cell Leukemia/Lymphoma Patients after Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Analysis in the Nagasaki Transplant Group

• Itonaga, Hidehiro

• Taguchi, Jun

• Fukushima, Takuya

• Tsushima, Hideki

• Sato, Shinya

• Ando, Koji

• Sawayama, Yasushi

• Matsuo, Emi

• Yamasaki, Reishi

• Onimaru, Yasuyuki

• Imanishi, Daisuke

• Imaizumi, Yoshitaka

• Yoshida, Shinichiro

• Hata, Tomoko

• Moriuchi, Yukiyoshi

• Honda, Sumihisa

• Miyazaki, Yasushi

Abstract

Although allogeneic hematopoietic stem cell transplantation (allo-SCT) is performed as a curative option in adult T cell leukemia-lymphoma (ATL) patients, its high transplantation-related mortality raises a serious issue. The clinical features of infectious complications after transplantation are not well known. To analyze the impact of infections after allo-SCT for ATL, we retrospectively compared infectious complications in 210 patients at 3 institutions in Nagasaki prefecture between 1997 and 2009. There were 91 patients with acute myeloid leukemia (AML), 51 with acute lymphoblastic leukemia/lymphoblastic lymphoma (ALL/LBL), and 68 with ATL. No patient received ganciclovir or foscarvir as prophylaxis, and most patients received antifungal prophylaxis with fluconazole or itraconazole. The cumulative incidence of cytomegalovirus (CMV) infection at 3 years was 69.2% in ATL patients versus 54.4% in AML patients (P = .0255). Cumulative infection-related mortality was significantly higher in ATL patients than in the 2 other groups (ATL versus AML, P = .0496; ATL versus ALL/LBL, P = .0075), and most death-causing pathogens were bacteria and fungus. The appearance of CMV infection was negatively associated with infectious mortality in ATL patients, but the P value for this association was near the borderline of significance (P = .0569). In multivariate analysis, transplantation using unrelated bone marrow and episodes of CMV infection were associated with worse overall survival in ATL patients, but were not in either AML or ALL/LBL patients. Collectively, the impact of infectious complications after transplantation in ATL patients was different from that in AML and ALL/LBL patients, suggesting that a more intensive strategy for infection control in ATL patients is required to reduce infectious mortality.

Biology of Blood and Marrow Transplantation, 19(4), pp.607-615; 2013

Journal

• Biology of Blood and Marrow Transplantation

  Biology of Blood and Marrow Transplantation 19 (4), 607-615, 2013-04

  Elsevier Inc.

Keywords

• Adult T cell leukemia-lymphoma
• Allogeneic hematopoietic stem cell transplantation
• Cytomegalovirus
• Infection

Details

• CRID: 1050287297275189376
• NII Article ID: 120006985927
• ISSN: 10838791
• HANDLE: 10069/32255
• Web Site: https://nagasaki-u.repo.nii.ac.jp/records/7399
• Text Lang: en
• Article Type: journal article
• Data Source:
  • IRDB
  • CiNii Articles