Infectious complications following allogeneic stem cell transplantation: reduced-intensity vs. myeloablative...

Area of Science:

• Hematology
• Transplantation Immunology
• Infectious Diseases

Background:

• Reduced-intensity conditioning (RIC) in allogeneic stem cell transplantation (allo-SCT) is associated with lower toxicity.
• The impact of RIC on infection risk and infection-related mortality (IRM) after allo-SCT is not well-established.

Purpose of the Study:

• To compare the incidence and timing of infectious episodes and IRM between patients undergoing allo-SCT with RIC versus myeloablative conditioning (MAC).

Main Methods:

• Retrospective analysis of infectious episodes and IRM in 81 RIC and 150 MAC allo-SCT recipients.
• Comparison of infection rates, onset timing, and specific infection types between RIC and MAC groups.

Main Results:

• Patients in the RIC group had a lower cumulative incidence of any infection (72% vs. 87%, P = 0.007) and delayed infection onset (P = 0.012).
• Bacteremia was less frequent in the RIC group (5% vs. 14%, P = 0.044).
• No significant differences were observed in cytomegalovirus reactivation, herpes zoster, hemorrhagic cystitis, invasive fungal infections, relapse-free survival, or IRM between RIC and MAC groups.

Conclusions:

• While RIC reduces overall infection rates and delays onset, specific severe infections and IRM are comparable to MAC.
• Allo-SCT recipients with RIC require vigilant monitoring and infection management strategies similar to those for MAC recipients, particularly post-engraftment.