Epidemiology of early infections following haploidentical, unmanipulated, G-CSF-primed bone marrow transplantation in patients with high-risk haematological malignancies.

Objective: The spectrum of infections that develop among patients who receive unmanipulated, G-CSF-primed bone marrow transplantation from a haploidentical family donor has not been described. Therefore, we evaluated incidence and type of infections occurring in this setting during the first 100 days after transplantation. Methods: Data regarding infectious episodes and outcome during the first 100 days after transplantation were retrospectively analyzed for 53 consecutive patients (30 in complete remission and 23 in refractory or recurrent active disease) undergoing haploidentical BMT. Results: The probability of overall survival for patients at 100 days post-haplo BMT was 83%(s.d.+5). The 100-day cumulative incidence of grade II-IV acute GVHD was 30, 2% (s.d.+4). We observed 63 viral infections in 43 patients, 60 bacterial infections in 53 patients and 10 fungal infections in 8 patients. Furthermore, 40 out of 53 patients (75%) reactivated Cytomegalovirus infection, and 20 patients (38%) showed BK viruria. Encephalitis occurred in 2 patients due to JCV and BKV, respectively. A vesicular rash due to adenovirus was documented in 1 patient. Twenty-six (49%) patients had septicemia with or without septic shock, 30 (56%) patients had catheter-related infections, 17 (32%) patients had pneumonia (2 due to infection with a K. pneumoniae carbapenemase producer and 1 with Chlamydia pneumoniae) and 1 patient had meningitis. One proven, 4 probable, and 3 possible fungal infections were documented in 8 (15%) patients. Overall, 9 of 53 (17%) patients died within 100 days after transplant. For 8 of these 9 patients (4/30 in the complete remission group, 4/23 in the active disease group) an infectious disease (1 hepatic abscess, 3 cases of septicaemia, 2 cases of encephalitis, 1 case of pneumonia, and 1 case of haemorrhagic cystitis) was the main cause of death. The infection-free survival at 100 days was 85%. Conclusion: Fifteen per cent of the patients studied died from infections during the first 100 days post-transplant. No diff erences in the percentage of subjects died for infection were observed between standard and high risk group of patients.