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Induction of Alloantigen-specific Anergy in Human Peripheral Blood Mononuclear Cells by Alloantigen Stimulation with Co-stimulatory Signal Blockade

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Antibiotic Prophylaxis During Allogeneic Stem Cell transplantation-A Comprehensive Single Center Retrospective

Charlotte K F Neuerburg¹, Friederike Schmitz¹, Marie-Therese Schmitz²

¹Department of Oncology, Hematology, Immuno-Oncology and Rheumatology, University Hospital Bonn, Bonn, Germany; Center for Integrated Oncology (CIO) ABCD, Aachen Bonn Cologne Düsseldorf, Germany.

Transplantation and Cellular Therapy

|September 19, 2024

Summary

Discontinuing antibiotic prophylaxis during allogeneic hematopoietic stem cell transplantation (allo-HSCT) showed noninferior outcomes, with comparable survival and Graft-versus-Host disease (GvHD) rates. Close monitoring is crucial for patients undergoing allo-HSCT without prophylactic antibiotics.

Keywords:

Allogeneic stem cell transplantation Antibiotic prophylactic therapy GvHD Infection Multiresistant bacteria

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Published on: August 12, 2017

Area of Science:

Hematology
Transplantation Medicine
Infectious Disease

Background:

Prophylactic antibiotic use in allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a debated topic.
This study investigated outcomes after a center's decision to suspend antibiotic prophylaxis during allo-HSCT.

Purpose of the Study:

To analyze the impact of omitting antibiotic prophylaxis on survival and Graft-versus-Host disease (GvHD) in allo-HSCT.
To evaluate risks of severe infections, mortality, and relapse without antibiotic prophylaxis.
To inform future antibiotic strategies in allo-HSCT.

Main Methods:

Retrospective analysis of 221 adult patients undergoing allo-HSCT before (n=101) and after (n=120) antibiotic prophylaxis suspension.
Used propensity score methods and inverse-propensity score weighted multistate modeling to adjust for confounders and competing events.
Collected data on overall survival, GvHD, infections, relapse, and mortality.

Main Results:

No significant differences were found in overall survival, acute or chronic GvHD between groups.
Multistate analysis confirmed comparable probabilities for survival, GvHD, and relapse.
Increased severe infections without prophylaxis did not significantly raise mortality; viral reactivation and multiresistant bacteria were similar, but *Clostridioides difficile* infections were higher with prophylaxis.

Conclusions:

Allo-HSCT without antibiotic prophylaxis appears noninferior with close monitoring and prompt intervention for suspected infections.
Observed trends towards improved outcomes without prophylaxis may be influenced by other advancements in care.
Further multicenter studies are warranted to confirm the potential benefits of omitting antibiotic prophylaxis in allo-HSCT.