Continued vigilance needed to prevent infections for HCT recipients

A recent study found late fatal infections (LFI) contributed to one-third of the deaths of both adult and pediatric patients who had survived more than 2 years after allogeneic hematopoietic cell transplantation (HCT). The results highlight the importance of ongoing monitoring and preventive measures for infections after HCT.

Researchers analyzed the incidence, infection types and risk factors contributing to LFI. The study included 10,336 adult and 5,088 pediatric patients who survived more than 2 years post-HCT without relapse. Of these, 2,245 adult and 377 pediatric patients died, with LFI contributing to the deaths of 687 (31%) and 110 (29%) patients respectively.

For adults, there was a continuous risk of infection after 2 years. Significant mortality risk factors included: 

  • Increasing age (20-39, 40-54 and ≥ 55 vs 18-19 years) with hazard ratio (HR) of 3.12 (95% CI: 1.33-7.32), 3.86 (95% CI: 1.66-8.95) and 5.49 (95% CI: 2.32-12.99)
  • History of chronic graft-versus-host disease (cGVHD) with ongoing immunosuppression 2 years post-HCT as compared to no history of GVHD (HR 3.87, 95% CI: 2.59-5.78)

For pediatric patients, the risk of infection was significantly smaller over time. For this group, the three most significant risks for developing LFI included: 

  • History of cGVHD with (HR 9.49, 95% CI: 4.39-20.51) or without (HR 2.7, 95% CI: 1.05-7.43) ongoing immunosuppression 2 years post-HCT as compared to no history of GVHD
  • Diagnosis of inherited abnormalities of erythrocyte function as compared to diagnosis of acute myeloid leukemia (HR 2.30, 95% CI: 1.19-4.42)
  • Age >10 years (HR 1.92, 95% CI: 1.15-3.2)

Based on these results, the researchers emphasize the importance of informing HCT survivors of their long-term infection risks. They stress the critical role community health care providers play in awareness of the infection risks and ensuring recipients receive post-transplant vaccinations and practice avoidance of infectious exposures to decrease infection risk. 

Norkin M, Shaw BE, Brazauskas R, et al. Bio Blood Marrow Transplant