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- Title
Clinical impact of colonization with multidrug-resistant organisms on outcome after allogeneic stem cell transplantation in patients with acute myeloid leukemia.
- Authors
Scheich, Sebastian; Lindner, Sarah; Koenig, Rosalie; Reinheimer, Claudia; Wichelhaus, Thomas A.; Hogardt, Michael; Besier, Silke; Kempf, Volkhard A. J.; Kessel, Johanna; Martin, Hans; Wilke, Anne C.; Serve, Hubert; Bug, Gesine; Steffen, Björn
- Abstract
<bold>Background: </bold>Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a curative treatment option for patients with acute myeloid leukemia (AML). During transplantation, patients undergo a period of severe neutropenia, which puts them at high risk for infectious complications. However, the impact of patient colonization with multidrug-resistant organisms (MDRO) on overall survival remains unclear.<bold>Methods: </bold>In this retrospective, single-center study, the authors analyzed data from 264 patients with AML who underwent a first allo-HSCT between January 2006 and March 2016 at their institution. Primary endpoints were overall survival and nonrelapse-related mortality.<bold>Results: </bold>One hundred forty-two of 264 patients (53.8%) were colonized by at least 1 MDRO, mainly with vancomycin-resistant Enterococcus faecalis/faecium (n = 122). The characteristics of colonized patients did not differ from those of MDRO-negative patients with respect to median age (53.5 vs 53 years), cytogenetic risk according to European LeukemiaNet criteria, remission status before allo-HSCT (first or second complete remission: 55.7% vs 60.7%, respectively; active disease: 44.4% vs 39.3%, respectively), donor type, or hematopoietic cell transplantation-comorbidity index (HCT-CI). Compared with noncolonized patients, MDRO-positive patients had an inferior probability of survival at 5 years (43.3% vs 65.5%; P = .002), primarily because of a higher cumulative incidence of nonrelapse-related mortality (33.9% vs 9.4%; P < .001). Death caused by infections occurred in 15.5% of colonized patients versus 4.9% of noncolonized patients. There was no difference in the cumulative incidence of relapse in MDRO-positive versus MDRO-negative patients (33.8% vs 42.1%, respectively; P = .798).<bold>Conclusions: </bold>The current data emphasize the importance of regular MDRO screenings and prompt further investigations into the impact of colonization with MDRO on the immune system after allo-HSCT. Cancer 2018;124:286-96. © 2017 American Cancer Society.
- Subjects
HEMATOPOIETIC stem cell transplantation; ACUTE myeloid leukemia; MULTIDRUG resistance; NEUTROPENIA; STEM cell transplantation; PROGNOSIS; ACUTE myeloid leukemia treatment; COMPARATIVE studies; DRUG resistance in microorganisms; ENTEROCOCCUS; GRAFT versus host disease; HOMOGRAFTS; RESEARCH methodology; MEDICAL cooperation; RESEARCH; VANCOMYCIN resistance; EVALUATION research; RETROSPECTIVE studies
- Publication
Cancer (0008543X), 2018, Vol 124, Issue 2, p286
- ISSN
0008-543X
- Publication type
journal article
- DOI
10.1002/cncr.31045