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2024-09-25T07:21:50.000Z

Interventional antibiotic treatment vs systemic antibiotic prophylaxis in patients undergoing allo-HSCT

Sep 25, 2024
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Learning objective: After reading this article, learners will be able to cite a new clinical development in graft-versus-host disease.

SAP during neutropenia is commonly used in patients undergoing allo-HSCT to reduce the risk of BSI. However, this approach can disrupt the intestinal microbiome, increasing the risk of GvHD and colonization with multidrug-resistant organisms.1 A retrospective analysis assessed the safety and efficacy of IAT in adult patients undergoing allo-HSCT (n = 68) compared with SAP-treated patients (n = 67). Results from this analysis were published in Annals of Hematology by Toenges et al.1

Key learnings:

IAT was associated with a shorter median duration of antibiotic treatment (18 days vs 24 days) compared with SAP, resulting in lower patient antibiotic exposure (p = 0.0001). 

IAT was linked with a higher cumulative incidence of BSI in the first 100 days post-transplant vs SAP (40% vs 13%; p < 0.001), but did not impact OS at 3 years (66% vs 68.9%), increase NRM at 3 years (10.96% vs 9.75%), or result in ICU admissions (13% vs 6%), supporting the safety of the IAT approach.  

The cumulative incidence of acute GvHD Grade 2–4 at 100 days (38.71% vs 29.85%; p = 0.307) and chronic GvHD of any grade at 3 years (44.75% vs 50.01%; p = 0.952) was similar between the IAT and SAP groups, although there was a trend toward less severe chronic GvHD in the IAT cohort (13.46% vs 27.86%; p = 0.098), suggesting a potential benefit of microbiome preservation. 

The findings suggest that replacing SAP with IAT is safe and feasible in clinical practice, providing an opportunity to limit antibiotic exposure without compromising outcomes in patients undergoing allo-HSCT. However, larger, prospective studies are warranted to confirm this potential benefit.  

Abbreviations: allo-HSCT, allogeneic hematopoietic stem cell transplantation; BSI, bloodstream infections; GvHD, graft-versus-host disease; IAT, interventional antibiotic treatment; ICU, intensive care unit; NRM, non-relapse mortality; OS, overall survival; SAP, systemic antibiotic prophylaxis. 

  1. Toenges R, Lang F, Ghaffar R, et al. Interventional antibiotic treatment replacing antibiotic prophylaxis during allogeneic hematopoietic stem cell transplantation is safe and leads to a reduction of antibiotic administration. Ann Hematol. 2024. Online ahead of print. DOI: 10.1007/s00277-024-05986-4 

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