1542. Infectious complications in patients (pt) following umbilical cord blood transplant (UCBT) for hematologic malignancy
Session: Poster Abstract Session: Viruses and Bacteria in Immunocompromised Patients
Friday, October 5, 2018
Room: S Poster Hall
Posters
  • UCBT ID week poster FINAL.pdf (352.2 kB)
  • Background: UCBT can be performed in pt with hematologic malignancies who do not have a matched donor, but engraftment often takes longer than with a standard allogeneic stem cell transplant. Delayed engraftment can increase the risk for infections, but characteristics of specific infections & outcomes have not been well characterized in adults undergoing UCBT.

    Methods: All adults who underwent UCBT between 1/1/06 and 1/1/16 at our 2 centers were included. Infectious episodes within 6 months before & up to 2 years after UCBT were reviewed.

    Results: 57 pt underwent UCBT. Mean age was 43±14 years, & 34 pt were women. 39 (60%) had acute leukemia. Only 47 pt had neutrophil engraftment. 179 infectious episodes occurred in 55 pt, 73 (41%) within 30 days (d) post UCBT. Viruses caused 85 (47%) infections. HHV-6 occurred in 28 episodes, 24 of which were viremia alone, & was most common within 30 d of UCBT. One pt died of HHV-6 encephalitis. CMV caused 32 infectious episodes, 24 of which were viremia only, was most common from d 30-100, & caused no deaths. BK viruria occurred in 18 episodes. Bacteria were responsible for 82 (46%) infections; most common were bacteremias due to Staphylococcus, van-R Enterococcus & Enterobacteriaceae. 3 pt had mycobacterial infections, 2 of which were fatal. Of 11 invasive fungal infections (IFI), 9 were invasive aspergillosis, of which 4 were fatal. Overall mortality was 56% in the 1st year, including 13 deaths from infection. Eleven of these 13 infections occurred in the first 100 d post-UCBT & 7 of them in the first 30 d. Pt who died within 100 d were significantly more likely to have had IFI (p=.04) or infection with VRE (p=.03) or Enterobacteriaceae (p=.03) within 30 d after UCBT. Among the 10 pt who never had neutrophil engraftment, 9 died within 100 d post-UCBT, 6 from infection.

    Conclusion: Infectious complications were common after UCBT, especially in the first 30 d. Deaths from viral infections were fewer than expected, most likely because of increased screening & prophylaxis for CMV infections. Delayed engraftment and non-engraftment continue to convey increased risk for fatal bacterial & fungal infections post-UCBT.

    Kathleen A. Linder, MD1, Philip McDonald, MD2, Carol A. Kauffman, MD3, Sanjay G. Revankar, MD2, Pranatharthi H. Chandrasekar, MD2 and Marisa H. Miceli, MD1, (1)Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, (2)Division of Infectious Diseases, Department of Internal Medicine, Wayne State University, Detroit, MI, (3)Division of Infectious Diseases, Department of Internal Medicine, University of Michigan and Ann Arbor VA Healthcare System, Ann Arbor, MI

    Disclosures:

    K. A. Linder, None

    P. McDonald, None

    C. A. Kauffman, None

    S. G. Revankar, None

    P. H. Chandrasekar, None

    M. H. Miceli, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.