Alternative graft sources (umbilical cord blood [UCB], matched unrelated donors [MUD], or mismatched unrelated donors [MMUD]) enable patients without a matched sibling donor to receive potentially curative hematopoietic cell transplantation (HCT). Retrospective studies demonstrate comparable outcomes among different graft sources. However, the risk and types of infections have not been compared among graft sources. Such information may influence the choice of a particular graft source. We compared the incidence of bacterial, viral, and fungal infections in 1781 adults with acute leukemia who received alternative donor HCT (UCB, n= 568; MUD, n = 930; MMUD, n = 283) between 2008 and 2011. The incidences of bacterial infection at 1 year were 72%, 59%, and 65% (P < .0001) for UCB, MUD, and MMUD, respectively. Incidences of viral infection at 1 year were 68%, 45%, and 53% (P < .0001) for UCB, MUD, and MMUD, respectively. In multivariable analysis, bacterial, fungal, and viral infections were more common after either UCB or MMUD than after MUD (P < .0001). Bacterial and viral but not fungal infections were more common after UCB than MMUD (P = .0009 and <.0001, respectively). The presence of viral infection was not associated with an increased mortality. Overall survival (OS) was comparable among UCB and MMUD patients with Karnofsky performance status (KPS) ≥ 90% but was inferior for UCB for patients with KPS < 90%. Bacterial and fungal infections were associated with poorer OS. Future strategies focusing on infection prevention and treatment are indicated to improve HCT outcomes.
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Financial disclosure: The CIBMTR is supported by public health service grant/cooperative agreement 5U24-CA076518 from the National Cancer Institute , the National Heart, Lung and Blood Institute , and the National Institute of Allergy and Infectious Diseases ; a grant/cooperative Agreement 5U10HL069294 from NHLBI and NCI ; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS) ; 2 grants N00014-13-1-0039 and N00014-14-1-0028 from the Office of Naval Research ; and grants from Alexion ; † Amgen, Inc. ; an anonymous donation to the Medical College of Wisconsin ; Be the Match Foundation ; † Bristol Myers Squibb Oncology ; † Celgene Corporation ; † Chimerix, Inc. ; Fred Hutchinson Cancer Research Center ; Gamida Cell Ltd. ; Genentech, Inc. ; Genzyme Corporation ; † Gilead Sciences, Inc. ; Health Research, Inc. Roswell Park Cancer Institute ; HistoGenetics, Inc. ; Incyte Corporation ; † Jazz Pharmaceuticals, Inc. ; Jeff Gordon Children's Foundation ; The Leukemia & Lymphoma Society ; The Medical College of Wisconsin ; Merck & Co, Inc. ; Mesoblast ; † Millennium : The Takeda Oncology Co. ; † Miltenyi Biotec, Inc. ; National Marrow Donor Program ; Neovii Biotech NA, Inc. ; Novartis Pharmaceuticals Corporation ; Onyx Pharmaceuticals ; Optum Healthcare Solutions, Inc. ; Otsuka America Pharmaceutical, Inc. ; Otsuka Pharmaceutical Co, Ltd. – Japan ; Oxford Immunotec ; Perkin Elmer, Inc. ; Pharmacyclics ; † Sanofi US ; Seattle Genetics ; Sigma-Tau Pharmaceuticals ; † Spectrum Pharmaceuticals, Inc. ; St. Baldrick's Foundation ; † Sunesis Pharmaceuticals, Inc. ; Swedish Orphan Biovitrum, Inc. ; Telomere Diagnostics, Inc. ; TerumoBCT ; Therakos, Inc. ; University of Minnesota ; and † Wellpoint, Inc. The views expressed in this article do not reflect the official policy or position of the National Institute of Health, the Department of the Navy, the Department of Defense, Health Resources and Services Administration or any other agency of the US Government. † Indicates corporate members.
© 2016 The American Society for Blood and Marrow Transplantation
- Umbilical cord blood