Pre-engraftment infectious complications and patient outcomes after allogeneic hematopoietic cell transplantation: a sin
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ORIGINAL PAPER
Pre‑engraftment infectious complications and patient outcomes after allogeneic hematopoietic cell transplantation: a single‑center experience from Lebanon Rima Moghnieh1,2 · Hani Tamim3 · Amin Abyad4 · Marwa Jadayel5 · Lyn Awad6 · Dania Abdallah6 · Nicholas Haddad7 · Jessica Berberi8 · Rawya Alwazir8 · Rida Taher8 · Tamima Jisr9 · Rawad Lakkis10 · Kamal Zahran11 · Ahmad Ibrahim4 Received: 28 October 2019 / Accepted: 2 March 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Infectious complications are significant causes of morbidity and mortality after allogeneic hematopoietic cell transplantation (allo-HCT). They occur variably over different periods, with scant data reported from Lebanon and neighboring countries. In this study, we described the pre-engraftment neutropenic phase, febrile episodes, and peri-transplant medical complications in patients undergoing allo-HCT at a tertiary-care hospital. Methods This is a retrospective chart review of patients who underwent allo-HCT between 2007 and 2016 at Makassed General Hospital in Beirut, Lebanon. Data were extracted from medical records, the HCT registry, and medical laboratory logbooks. Results One hundred and six patients were included, 75% having hematologic malignancies and 13% aplastic anemia. None received antibacterial prophylaxis with fluoroquinolones. Yet from conditioning chemotherapy till the say before HCT, 32% of the patients received broad-spectrum antibiotics (BSA) due to fever or infection. At the day of cell infusion, 41.5% of the patients were on BSA. Neutrophil engraftment failure was recorded in 8% of the patients. The cumulative incidence of pre-engraftment bacteremia and Gram-negative bacteremia was 14.3 and 7.1%, respectively. Aplastic anemia was an independent risk factor for pre-engraftment bacteremia [hazard ratio (HR) = 3.86, 95% confidence interval (CI) (1.29–11.5), P = 0.02]. The cumulative incidence of pre-engraftment pneumonia was 11.2%. Patient age significantly increased the risk of pre-engraftment pneumonia [HR = 12.35, 95% CI (1.27–120.50), P = 0.03]. Six-month post-transplant mortality reached 17% in our cohort. Myelodysplastic syndrome was the only significant parameter increasing the risk of death [HR = 3.40, 95% CI (1.05–10.98), P = 0.04]. Conclusion The cumulative incidence of pre-engraftment bacteremia and pneumonia was 14.3% and 11.2% respectively in this cohort. Aplastic anemia predicted for the occurrence of bacteremia, increasing patient age contributed to the occurrence of pneumonia, and myelodysplastic syndrome increased the risk of death. Keywords Allogeneic hematopoietic cell transplantation · Pre-engraftment period · Pneumonia · Bacteremia · Mortality
Rima Moghnieh and Hani Tamim have equally contributed to the work. Amin Abyad, Marwa Jadayel, and Lyn Awad have equally contributed to the work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s15010-020-01407-6) contains supplementary material, which is avail
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