Incidence and outcome of infections after allogeneic hematopoietic stem cell transplantation (HSCT) with post-transplant cyclophosphamide (PT-Cy) as graft-versus-host disease (GVHD) prophylaxis are largely unknown. Study aims were to estimate the incidence of pre-engraftment bloodstream infections (PE-BSIs) and viral infections (VIs; cytomegalovirus [CMV], adenovirus [ADV], human herpes virus 6 [HHV6], and BK-polyomavirus hemorrhagic-cystitis [BKPyV-HC]), their predictive factors, and infection-related mortality (IRM) after HSCT with PT-Cy. We analyzed 235 patients: 62%, 21%, and 17% received haploidentical (haplo), matched-unrelated donor (MUD), and matched-related donor, respectively. Overall, 72 patients had 77 PE-BSI episodes at a median time of 13 days after HSCT: cumulative incidence function (CIF) at 28 days was 32%, without differences among donor types (P = .988). By multivariate analysis, CIF of PE-BSI was higher in patients with severe neutropenia before HSCT (adjusted hazard ratio [AHR] = 2.90) and in multidrug-resistant Gram-negative bacteria rectal carriers (AHR = 2.68). IRM at 30 days was 5%, without differences by donor type (P = .106). Overall, 208 patients experienced ≥1 VIs (first occurrence among CMV, HHV6, ADV, BKPyV-HC) at a median time of 20 days after HSCT: CIF at 90 days was 91%, significantly higher in MUD and haplo (P = .0089). By multivariate analysis, also acute GVHD grade ≥2 (AHR = 1.32) and host/donor CMV-serology mismatch (positive/positive versus negative/negative: AHR = 2.95, positive/negative versus negative/negative: AHR = 2.41, negative/positive versus negative/negative: AHR = 2.35) affected VIs occurrence. IRM at 180 days was 8%, without differences among donor types (P = .106). In conclusion, study results did not show a significant impact of donor type on PE-BSI incidence; conversely, MUD and haploidentical transplants retained a higher occurrence of VIs in the early phase after HSCT.

中文翻译：

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同种异体移植后移植环磷酰胺感染：供体HLA匹配的影响。

以移植后环磷酰胺（PT-Cy）作为移植物抗宿主病（GVHD）的预防措施，进行异基因造血干细胞移植（HSCT）后，感染的发生率和结果尚不清楚。研究目的是评估植入前血流感染（PE-BSIs）和病毒感染（VIs；巨细胞病毒[CMV]，腺病毒[ADV]，人疱疹病毒6 [HHV6]和BK多瘤病毒出血性膀胱炎[ BKPyV-HC]），它们的预测因素以及PT-Cy进行HSCT后的感染相关死亡率（IRM）。我们分析了235例患者：分别接受单倍型（haplo），匹配不相关供体（MUD）和匹配相关供体的62％，21％和17％。总体而言，有72位患者在HSCT后的中位时间13天出现77次PE-BSI发作：28天的累积发生率（CIF）为32％，供体类型之间无差异（P = .988）。通过多变量分析，HSCT之前患有严重中性粒细胞减少症的患者（调整后的危险比[AHR] = 2.90）和多药耐药的革兰氏阴性细菌直肠携带者（AHR = 2.68）的PE-BSI的CIF较高。30天的IRM为5％，各供体类型无差异（P = .106）。总体而言，在HSCT后20天的中位时间，有208例患者经历了≥1 VIs（CMV，HHV6，ADV，BKPyV-HC中首次出现）：90天的CIF为91％，MUD和单倍体显着更高（P =。 0089）。通过多变量分析，急性GVHD≥2（AHR = 1.32）和宿主/供体CMV血清学不匹配（阳性/阳性与阴性/阴性：AHR = 2.95，阳性/阴性与阴性/阴性：AHR = 2.41，阴性/阳性与阴性/阴性：AHR = 2.35）影响了VI的发生。180天的IRM为8％，供体类型之间无差异（P = .106）。总之，研究结果并未显示供体类型对PE-BSI发生率有显着影响。相反，在HSCT早期，MUD和单倍体移植保留了较高的VI发生率。