Fewer infections and lower infection-related mortality following non-myeloablative versus myeloablative conditioning for allotransplantation of patients with lymphoma

V. Bachanova, C. G. Brunstein, L. J. Burns, J. S. Miller, X. Luo, T. Defor, J. Ah Young, D. J. Weisdorf, M. Tomblyn

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

Non-myeloablative (NMA) allogeneic donor SCT for patients with relapsed lymphoma is associated with lower treatment-related mortality (TRM). However, the impact of conditioning intensity on post transplant infections remains unclear. We evaluated infections in 141 consecutive patients with lymphoma who were allografted using NMA (n = 76) or myeloablative (MA; n = 65) conditioning regimens. Using infection incidence density per 1000 patient days, we accounted for all infectious episodes during the first post transplant year. Before neutrophil engraftment, the NMA cohort had a 53% lower rate of bacterial infection (relative risk = 0.47; P = 0.06), whereas after engraftment the density of bacterial infections was similar in the two groups. In the first month, both invasive fungal infections and viral infections were twofold less frequent (P = 0.22; P = 0.06) in NMA patients. Late viral and fungal infections as well as CMV reactivation were infrequent after either conditioning intensity. The 1-year infection-related mortality was significantly lower after NMA conditioning (NMA 9% (3-16%) vs MA 22% (11 - 40%); P = 0.03). NMA allogeneic transplantation for lymphoma patients results in substantially fewer early infections and lower infection-related deaths, although the similar frequency of later infections suggests that immune reconstitution is delayed with either conditioning intensity.

Original languageEnglish (US)
Pages (from-to)237-244
Number of pages8
JournalBone marrow transplantation
Volume43
Issue number3
DOIs
StatePublished - 2009

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