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Distinct Clinical Features of Infectious Complications in Adult T Cell Leukemia/Lymphoma Patients after Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Analysis in the Nagasaki Transplant Group


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Title: Distinct Clinical Features of Infectious Complications in Adult T Cell Leukemia/Lymphoma Patients after Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Analysis in the Nagasaki Transplant Group
Authors: Itonaga, Hidehiro / Taguchi, Jun / Fukushima, Takuya / Tsushima, Hideki / Sato, Shinya / Ando, Koji / Sawayama, Yasushi / Matsuo, Emi / Yamasaki, Reishi / Onimaru, Yasuyuki / Imanishi, Daisuke / Imaizumi, Yoshitaka / Yoshida, Shinichiro / Hata, Tomoko / Moriuchi, Yukiyoshi / Honda, Sumihisa / Miyazaki, Yasushi
Issue Date: Apr-2013
Publisher: Elsevier Inc.
Citation: Biology of Blood and Marrow Transplantation, 19(4), pp.607-615; 2013
Abstract: Although allogeneic hematopoietic stem cell transplantation (allo-SCT) is performed as a curative option in adult T cell leukemia-lymphoma (ATL) patients, its high transplantation-related mortality raises a serious issue. The clinical features of infectious complications after transplantation are not well known. To analyze the impact of infections after allo-SCT for ATL, we retrospectively compared infectious complications in 210 patients at 3 institutions in Nagasaki prefecture between 1997 and 2009. There were 91 patients with acute myeloid leukemia (AML), 51 with acute lymphoblastic leukemia/lymphoblastic lymphoma (ALL/LBL), and 68 with ATL. No patient received ganciclovir or foscarvir as prophylaxis, and most patients received antifungal prophylaxis with fluconazole or itraconazole. The cumulative incidence of cytomegalovirus (CMV) infection at 3 years was 69.2% in ATL patients versus 54.4% in AML patients (P = .0255). Cumulative infection-related mortality was significantly higher in ATL patients than in the 2 other groups (ATL versus AML, P = .0496; ATL versus ALL/LBL, P = .0075), and most death-causing pathogens were bacteria and fungus. The appearance of CMV infection was negatively associated with infectious mortality in ATL patients, but the P value for this association was near the borderline of significance (P = .0569). In multivariate analysis, transplantation using unrelated bone marrow and episodes of CMV infection were associated with worse overall survival in ATL patients, but were not in either AML or ALL/LBL patients. Collectively, the impact of infectious complications after transplantation in ATL patients was different from that in AML and ALL/LBL patients, suggesting that a more intensive strategy for infection control in ATL patients is required to reduce infectious mortality.
Keywords: Adult T cell leukemia-lymphoma / Allogeneic hematopoietic stem cell transplantation / Cytomegalovirus / Infection
URI: http://hdl.handle.net/10069/32255
ISSN: 10838791
DOI: 10.1016/j.bbmt.2013.01.011
Rights: © 2013 American Society for Blood and Marrow Transplantation. / NOTICE: this is the author’s version of a work that was accepted for publication in Biology of Blood and Marrow Transplantation. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Biology of Blood and Marrow Transplantation, 19, 4(2013)
Type: Journal Article
Text Version: author
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/32255

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