Steroid-Sensitive, but Not Steroid-Dependent or Steroid-Resistant Acute Graft-versus-Host Disease, Results in Similar Infection Risk as No Graft-versus-Host Disease following Allogeneic Hematopoietic Cell Transplantation

Jo-Anne H Young; Najla El Jurdi; Ahmad Rayes; Margaret L MacMillan; Shernan G Holtan; Qing Cao; Judith Witte; Mukta Arora; Daniel J Weisdorf

doi:10.1016/j.jtct.2022.05.008

Steroid-Sensitive, but Not Steroid-Dependent or Steroid-Resistant Acute Graft-versus-Host Disease, Results in Similar Infection Risk as No Graft-versus-Host Disease following Allogeneic Hematopoietic Cell Transplantation

Transplant Cell Ther. 2022 Aug;28(8):509.e1-509.e11. doi: 10.1016/j.jtct.2022.05.008. Epub 2022 May 14.

Authors

Jo-Anne H Young¹, Najla El Jurdi², Ahmad Rayes³, Margaret L MacMillan³, Shernan G Holtan², Qing Cao⁴, Judith Witte⁵, Mukta Arora², Daniel J Weisdorf²

Affiliations

¹ Department of Medicine, University of Minnesota, Minneapolis, Minnesota. Electronic address: vanbu004@umn.edu.
² Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Blood and Marrow Transplantation Program, University of Minnesota, Minneapolis, Minnesota.
³ Blood and Marrow Transplantation Program, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota.
⁴ Biostatistics and Informatics, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota.
⁵ Blood and Marrow Transplantation Program, University of Minnesota, Minneapolis, Minnesota.

PMID: 35577324
DOI: 10.1016/j.jtct.2022.05.008

Abstract

Patients with acute graft-versus-host disease (GVHD) have an increased risk for infectious complications after allogeneic hematopoietic cell transplantation (HCT), but the risk according to response to therapy has not been well studied. We performed a retrospective analysis of the infectious complications for 1 year following allogeneic HCT at the University of Minnesota including 1143 pediatric and adult patients with and without aGVHD. The patients with aGVHD were classified into treatment response groups based on response to corticosteroids as first-line therapy: steroid-sensitive (SS; n = 114), steroid-resistant (SR; n = 103), and steroid-dependent (SD; n = 168) aGVHD. We observed that the cumulative incidence and density of infections in patients with SS aGVHD parallel the values in patients without GVHD. Infection density (ie, number of infections occurring per 100 days at risk) was greater in the patients with aGVHD compared with patients in both early and later post-transplantation periods. In GVHD patients, among the infections developed from the onset of aGVHD through 80 days of treatment, and until 1 year following transplantation, SS and SD patients had fewer bacterial and viral infections than SR patients. The overlap of nonrelapse mortality between SS and SD GVHD patients is a function of SD GVHD being responsive to steroid therapy, even if continued therapy is required. In summary, although valid goals may include reducing unneeded antibacterial antibiotic therapy and preserving microbiome diversity, these data suggest that anti-infective therapy is justified by the density of infections observed during active GVHD treatment.

Keywords: Graft-versus-host disease; Hematopoietic cell transplantation; Opportunistic infections; Steroid-dependent; Steroid-refractory; Steroid-sensitive.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Child
Graft vs Host Disease* / drug therapy
Hematopoietic Stem Cell Transplantation* / adverse effects
Humans
Infections* / drug therapy
Retrospective Studies
Steroids / therapeutic use

Substances

Steroids