TY - JOUR
T1 - Bloodstream Infection Due to Vancomycin-resistant Enterococcus Is Associated with Increased Mortality after Hematopoietic Cell Transplantation for Acute Leukemia and Myelodysplastic Syndrome
T2 - A Multicenter, Retrospective Cohort Study
AU - Papanicolaou, Genovefa A.
AU - Ustun, Celalettin
AU - Young, Jo Anne H.
AU - Chen, Min
AU - Kim, Soyoung
AU - Woo Ahn, Kwang
AU - Komanduri, Krishna
AU - Lindemans, Caroline
AU - Auletta, Jeffery J.
AU - Riches, Marcie L.
AU - Abdel-Azim, Hisham
AU - Ahmed, Ibrahim A.
AU - Aljurf, Mahmoud
AU - Antin, Joseph
AU - Ballen, Karen Kuhn
AU - Beitinjaneh, Amer
AU - Brown, Valerie I.
AU - Cerny, Jan
AU - Champlin, Richard
AU - Chao, Nelson
AU - Chhabra, Saurabh
AU - Dahi, Parastoo B.
AU - Daly, Andrew
AU - Dandoy, Christopher
AU - Dvorak, Christopher C.
AU - Forman, Stephen
AU - Ganguly, Siddhartha
AU - Hashmi, Shahrukh K.
AU - Kharfan-Dabaja, Mohamed A.
AU - Lazarus, Hillard
AU - Ljungman, Per
AU - Malone, Adriana K.
AU - Murthy, Guru
AU - Nishihori, Taiga
AU - Page, Kristin
AU - Pingali, Ravi Sai Ravi
AU - Reddy, Vijay
AU - Saad, Ayman
AU - Savani, Bipin N.
AU - Seftel, Matthew
AU - Szer, Jeffrey
AU - Vij, Ravi
AU - Weisdorf, Daniel
AU - William, Basem M.
AU - Williams, Kirsten
AU - Wirk, Baldeep
AU - Yared, Jean
N1 - Funding Information:
Financial support. This work was supported by the National Institutes of Health (grant numbers P30 CA008748 and P01 CA023766). The CIBMTR® is supported primarily by a Public Health Service grant/cooperative agreement (grant number 5U24CA076518) from the National Cancer Institute (NCI), the National Heart, Lung, and Blood Institute (NHLBI), and the National Institute of Allergy and Infectious Diseases; a grant/co-operative agreement (grant number 1U24HL138660) from NHLBI and NCI; a contract (number HHSH250201700006C) with Health Resources and Services Administration/Department of Health and Human Services; 2 grants (grant numbers N00014-17-1-2388, N00014-17-1-2850, and N00014-18-1-2045) from the Office of Naval Research; and grants from the following: Adaptive Biotechnologies; *Amgen, Inc.; an anonymous donation to the Medical College of Wisconsin; Astellas Pharma US; Atara Biotherapeutics, Inc.; Be the Match Foundation; *bluebird bio, Inc.; *Bristol Myers Squibb Oncology; *Celgene Corporation; *Chimerix, Inc.; *CytoSen Therapeutics, Inc.; Fred Hutchinson Cancer Research Center; Gamida Cell Ltd.; Gilead Sciences, Inc.; HistoGenetics, Inc.; Immucor; *Incyte Corporation; Janssen Scientific Affairs, LLC; *Jazz Pharmaceuticals, Inc.; Karius, Inc.; Karyopharm Therapeutics, Inc.; *Kite Pharma, Inc.; Medac, GmbH; *Mediware; the Medical College of Wisconsin; *Merck & Co, Inc.; *Mesoblast; MesoScale Diagnostics, Inc.; Millennium, the Takeda Oncology Co.; *Miltenyi Biotec, Inc.; Mundipharma EDO; National Marrow Donor Program; Novartis Pharmaceuticals Corporation; PCORI; *Pfizer, Inc; *Pharmacyclics, LLC; PIRCHE AG; *Sanofi Genzyme; *Seattle Genetics; Shire; Spectrum Pharmaceuticals, Inc.; St. Baldrick’s Foundation; Swedish Orphan Biovitrum, Inc.; *Takeda Oncology; and University of Minnesota. The asterisks indicate corporate membership. G. A. P. was partially funded by the NCI Cancer Center (support grant number P30 CA008748).
Publisher Copyright:
© 2019 The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
PY - 2019/11/15
Y1 - 2019/11/15
N2 - Background: We examined the impact of vancomycin-resistant Enterococcus (VRE) bloodstream infection (BSI) on outcomes of allogeneic hematopoietic cell transplantation (HCT) utilizing the Center for International Blood and Marrow Transplant Research database. Methods: Adult and pediatric patients (N = 7128) who underwent first HCT for acute leukemia or myelodysplastic syndrome from 2008 through 2012 were analyzed as 3 groups - VRE BSI, non-VRE BSI, without BSI - according to BSI status at 100 days (D100) after allogeneic HCT. Multivariable models examined the effect of VRE BSI for overall survival (OS) and nonrelapse mortality (NRM) at 1 year. Results: Of 7128 patients, 258 (3.2%) had VRE BSI, 2398 (33.6%) had non-VRE BSI, and 4472 (63%) had no BSI. The median time to VRE BSI and non-VRE BSI were D11 and D15, respectively. Compared with non-VRE BSI patients, VRE BSI patients were older, had advanced-stage acute leukemia, and received umbilical cord blood (UCB) allografts. In multivariable models, VRE BSI was associated with lower OS (relative risk [RR], 2.9;(99% confidence interval [CI], 2.2-3.7) and increased NRM (RR, 4.7; 99% CI, 3.6-6.2) (P <. 0001) for both. Other predictors for worse OS and increased NRM were non-VRE BSI, older age, advanced disease stage, UCB allograft, - mismatch, comorbidity index ≥3, and cytomegalovirus seropositivity (P <. 001 for all variables). Conclusions: VRE BSI is associated with lowest OS and highest NRM compared with patients without BSI or non-VRE BSI. Novel interventions that address the pathophysiology of VRE BSI have the potential of improving survival after HCT.
AB - Background: We examined the impact of vancomycin-resistant Enterococcus (VRE) bloodstream infection (BSI) on outcomes of allogeneic hematopoietic cell transplantation (HCT) utilizing the Center for International Blood and Marrow Transplant Research database. Methods: Adult and pediatric patients (N = 7128) who underwent first HCT for acute leukemia or myelodysplastic syndrome from 2008 through 2012 were analyzed as 3 groups - VRE BSI, non-VRE BSI, without BSI - according to BSI status at 100 days (D100) after allogeneic HCT. Multivariable models examined the effect of VRE BSI for overall survival (OS) and nonrelapse mortality (NRM) at 1 year. Results: Of 7128 patients, 258 (3.2%) had VRE BSI, 2398 (33.6%) had non-VRE BSI, and 4472 (63%) had no BSI. The median time to VRE BSI and non-VRE BSI were D11 and D15, respectively. Compared with non-VRE BSI patients, VRE BSI patients were older, had advanced-stage acute leukemia, and received umbilical cord blood (UCB) allografts. In multivariable models, VRE BSI was associated with lower OS (relative risk [RR], 2.9;(99% confidence interval [CI], 2.2-3.7) and increased NRM (RR, 4.7; 99% CI, 3.6-6.2) (P <. 0001) for both. Other predictors for worse OS and increased NRM were non-VRE BSI, older age, advanced disease stage, UCB allograft, - mismatch, comorbidity index ≥3, and cytomegalovirus seropositivity (P <. 001 for all variables). Conclusions: VRE BSI is associated with lowest OS and highest NRM compared with patients without BSI or non-VRE BSI. Novel interventions that address the pathophysiology of VRE BSI have the potential of improving survival after HCT.
KW - bacteremia
KW - hematopoietic stem cell transplantation
KW - mortality
KW - vancomycin-resistant Enterococcus (VRE)
UR - http://www.scopus.com/inward/record.url?scp=85066129430&partnerID=8YFLogxK
U2 - 10.1093/cid/ciz031
DO - 10.1093/cid/ciz031
M3 - Article
C2 - 30649224
AN - SCOPUS:85066129430
SN - 1058-4838
VL - 69
SP - 1771
EP - 1779
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 10
ER -