Pre-engraftment infectious complications and patient outcomes after allogeneic hematopoietic cell transplantation: a single-center experience from Lebanon.
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.
['Moghnieh|Rima|R|', 'Tamim|Hani|H|', 'Abyad|Amin|A|', 'Jadayel|Marwa|M|', 'Awad|Lyn|L|', 'Abdallah|Dania|D|', 'Haddad|Nicholas|N|', 'Berberi|Jessica|J|', 'Alwazir|Rawya|R|', 'Taher|Rida|R|', 'Jisr|Tamima|T|', 'Lakkis|Rawad|R|', 'Zahran|Kamal|K|', 'Ibrahim|Ahmad|A|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D016470:Bacteremia D002648:Child D002675:Child, Preschool D005260:Female D018380:Hematopoietic Stem Cell Transplantation D006801:Humans D015994:Incidence D007223:Infant D007231:Infant, Newborn D007861:Lebanon D008297:Male D008875:Middle Aged D012189:Retrospective Studies D012307:Risk Factors D062606:Tertiary Care Centers D014184:Transplantation, Homologous D055815:Young Adult
Allogeneic hematopoietic cell transplantation Mortality Bacteremia Pneumonia Pre-engraftment period