aGvHD

Gastrointestinal graft-versus-host disease increases the risk of post-engraftment bloodstream infections

Yasuo Mori from Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan, and colleagues conducted a retrospective study to evaluate the etiology, morbidity, outcomes, and risk factors of bloodstream infection (BSI) in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). The study was published ahead of print in Biology of Bone and Marrow Transplantation.

Patients and methods:
  • N = 346 patients
  • Median age = 49 years (16–72)
  • Allo-HSCT: between July 2009 and December 2016
Key findings:
  • Post-engraftment period BSI (PE-BSI): 43/316 (13.6%)
    • 30 patients had one PE-BSI episode
    • 12 patients had two episodes
    • One patient had three episodes
  • The median onset of first PE-BSI: 65 days (18–154) after transplant
  • 62 pathogens were identified: gram-positive bacteria, gram-negative bacteria, and fungi: 54.8% vs5% vs 9.7%
  • Incidence of acute GvHD (grade II to IV) in patients with and without PE-BSI: 36/43 (83.7%) vs 112/273 (41.0%), P < 0.0001
  • Risk factors for PE-BSI:
    • Acute gastrointestinal (GI) GvHD: odds ratio (OR) = 8.82 (95% CI, 3.99–5), P < 0.0001
    • Methylprednisolone usage as GvHD prophylaxis: OR = 6.49 (95% CI, 1.49–2), P = 0.013
  • 3-year overall survival in patients with PE-BSI compared with those without PE-BSI: 47.0% vs6%, P < 0.001

Taken together, this study indicates that GI-GvHD increases the risk of post-engraftment blood stream infections. The authors suggested that “microbiological monitoring for BSIs and minimizing intestinal dysbiosis may be crucial to break the vicious cycle between GI-GvHD and bacteremia, consequently improve transplant outcomes especially in patients who require additional immunosuppressants.” Providing therapy with novel agents and supportive care for subsequent PE-BSI may improve outcomes and reduce therapy-related mortality.

Reference
  1. Mori Y. et al. Gastrointestinal graft-versus-host disease is a risk factor for post-engraftment blood stream infection in allogeneic hematopoietic stem cell transplant recipients. Biol Blood Marrow Transplant. 2018 Jun 14. DOI: 10.1016/j.bbmt.2018.06.002. [Epub ahead of print].
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