Decrease of lethal infectious complications in the context of causes of death (COD) after hematopoietic cell...

Area of Science:

• Hematology
• Transplantation Immunology
• Infectious Diseases

Background:

• Hematopoietic stem cell transplantation (HCT) is a critical treatment for various hematologic malignancies and disorders.
• Understanding causes of death (COD) post-HCT is crucial for improving patient outcomes.
• Previous studies (COD-1) analyzed mortality trends in acute and chronic leukemias.

Purpose of the Study:

• To analyze the incidence and specific causes of death after HCT in a large patient cohort (COD-2 study).
• To specifically investigate infectious deaths in two distinct time periods (1980-2001 and 2002-2015).
• To compare findings with previous analyses of acute/chronic leukemias (COD-1 study).

Main Methods:

• Retrospective analysis of 232,618 patients undergoing HCT for lymphoma, plasma cell disorders, chronic leukemia (excluding CML), and MDS/MPN.
• Data sourced from the EBMT-ProMISe database.
• Comparison of mortality patterns between two cohorts (1980-2001 and 2002-2015) and between autologous (auto-HCT) and allogeneic (allo-HCT) transplantation.

Main Results:

• Infectious deaths decreased in early and intermediate phases post-HCT but increased for bacterial infections in the late phase.
• Autologous HCT consistently showed a lower incidence of all infection types across all phases compared to allogeneic HCT.
• Infections were the leading cause of death before day +100, followed by relapse.

Conclusions:

• Infections remain a major cause of early mortality post-HCT, with a significant overall decrease except in the late phase.
• Autologous HCT demonstrates a favorable safety profile with reduced infectious complications.
• Overall post-transplant mortality has significantly decreased, especially after autologous HCT, though late-phase mortality requires continued attention.