TY - JOUR
T1 - The incidence and impact of clostridioides difficile infection on transplant outcomes in acute leukemia and MDS after allogeneic hematopoietic cell transplant—a CIBMTR study
AU - Ramanathan, Muthalagu
AU - Kim, Soyoung
AU - He, Naya
AU - Chen, Min
AU - Hematti, Peiman
AU - Abid, Muhammad Bilal
AU - Rotz, Seth J.
AU - Williams, Kirsten M.
AU - Lazarus, Hillard M.
AU - Wirk, Baldeep
AU - Yin, Dwight E.
AU - Kanakry, Christopher G.
AU - Perales, Miguel Angel
AU - Chemaly, Roy F.
AU - Dandoy, Christopher E.
AU - Riches, Marcie
AU - Ustun, Celalettin
N1 - Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer Nature Limited.
PY - 2023/4
Y1 - 2023/4
N2 - Clostridioides difficile infection (CDI) is common after allogeneic hematopoietic cell transplantation (alloHCT). The determination of incidence, risk factors, and impact of CDI on alloHCT outcomes is an unmet need. The study examines all patients aged 2 years and older who received first alloHCT for acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), or myelodysplastic syndrome (MDS) between 2013 and 2018 at US centers and reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) data registry. In total, 826 patients with CDI and 6723 controls from 127 centers were analyzed. The cumulative incidence of CDI by day 100 was 18.7% (99% CI: 15–22.7%) and 10.2% (99% CI: 9.2–11.1%) in pediatric and adult patients, respectively, with a median time to diagnosis at day +13. CDI was associated with inferior overall survival (OS) (p = 0.0018) and a 2.58-fold [99% CI: 1.43–4.66; p < 0.001] increase in infection-related mortality (IRM). There was a significant overlap in the onset of acute graft versus host disease (aGVHD) and CDI. IRM increased to >4 fold when CDI + aGVHD was considered. Despite advances in the management of CDI, increased IRM and decreased OS still results from CDI.
AB - Clostridioides difficile infection (CDI) is common after allogeneic hematopoietic cell transplantation (alloHCT). The determination of incidence, risk factors, and impact of CDI on alloHCT outcomes is an unmet need. The study examines all patients aged 2 years and older who received first alloHCT for acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), or myelodysplastic syndrome (MDS) between 2013 and 2018 at US centers and reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) data registry. In total, 826 patients with CDI and 6723 controls from 127 centers were analyzed. The cumulative incidence of CDI by day 100 was 18.7% (99% CI: 15–22.7%) and 10.2% (99% CI: 9.2–11.1%) in pediatric and adult patients, respectively, with a median time to diagnosis at day +13. CDI was associated with inferior overall survival (OS) (p = 0.0018) and a 2.58-fold [99% CI: 1.43–4.66; p < 0.001] increase in infection-related mortality (IRM). There was a significant overlap in the onset of acute graft versus host disease (aGVHD) and CDI. IRM increased to >4 fold when CDI + aGVHD was considered. Despite advances in the management of CDI, increased IRM and decreased OS still results from CDI.
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U2 - 10.1038/s41409-022-01896-z
DO - 10.1038/s41409-022-01896-z
M3 - Article
C2 - 36543999
AN - SCOPUS:85144532838
SN - 0268-3369
VL - 58
SP - 360
EP - 366
JO - Bone marrow transplantation
JF - Bone marrow transplantation
IS - 4
ER -