Incidence and Risk Factors for Nontuberculous Mycobacterial Infection after Allogeneic Hematopoietic Cell Transplantation

被引:26
作者
Beswick, Jennifer [1 ]
Shin, Elizabeth [2 ]
Michelis, Fotios V. [2 ]
Thyagu, Santhosh [2 ]
Viswabandya, Auro [2 ]
Lipton, Jeffrey H. [2 ]
Messner, Hans [2 ]
Marras, Theodore K. [3 ,4 ]
Kim, Dennis [2 ]
机构
[1] Univ Toronto, Dept Med, Toronto, ON, Canada
[2] Univ Toronto, Univ Hlth Network, Princess Margaret Canc Ctr, Allogene Blood & Marrow Transplant Program,Dept M, Toronto, ON, Canada
[3] Univ Hlth Network, Div Respirol, Dept Med, Toronto, ON, Canada
[4] Univ Toronto, 399 Bathurst St,7 East,Room 452, Toronto, ON M5T 2S8, Canada
关键词
Hematopoietic stem cell transplantation; Allogeneic hematopoietic stem cell transplantation; Mycobacterium infections; Nontuberculous; Nontuberculous mycobacteria; VERSUS-HOST-DISEASE; CONSENSUS DEVELOPMENT PROJECT; PREVALENCE; DIAGNOSIS; RECIPIENTS; CRITERIA; SCORE;
D O I
10.1016/j.bbmt.2017.09.015
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Allogenic hematopoietic stem cell transplant (HCT) recipients are at risk of many infections. Nontuberculous mycobacteria (NTM) are increasingly recognized as clinically significant pathogens in this population. We investigated the incidence and risk factors for NTM infection after allogeneic HCT. This retrospective cohort study included all patients with allogeneic HCT at our institution during 2001 to 2013. Patients who developed significant NTM infection (NTM disease) were identified. Multivariable modeling was used to identify risk factors for NTM disease, and a risk score model was constructed to identify high-risk patients. Of 1097 allogeneic HCT patients, 45 (4.1%) had NTM isolated and 30 (2.7%) had NTM disease (28 [93.3%] exclusively pulmonary, 2 [6.7%] pulmonary plus another site). Incidence of NTM infection by competing risk analysis was 2.8% at 5 years (95% CI, 1.9% to 4.0%). The median time to diagnosis was 343 days (range, 19 to 1967). In Fine-Gray proportional hazards modeling, only global severity of chronic graft-versus-host disease (cGVHD) (HR, 1.99; 95% CI, 1.12 to 3.53; P = .019,) and cytomegalovirus (CMV) viremia (HR, 5.77; 95% CI, 1.71 to 19.45; P = .004) were significantly associated with NTM disease. Using these variables a risk score was calculated: 1 point for CMV viremia or moderate cGVHD and 2 points for severe cGVHD. The score divided patients into low risk (0 to 1 points, n = 820 [77.3%], 3-year NTM risk 1.2%), intermediate risk (2 points, n = 161 [15.4%], 3-year NTM risk 7.1%), and high risk (3 points, n = 56 [5.4%], 3-year NTM risk 14.3%). NTM disease after allogeneic HCT is common. Severe cGVHD and CMV viremia are associated with increased risk, permitting risk stratification. (C) 2017 American Society for Blood and Marrow Transplantation.
引用
收藏
页码:366 / 372
页数:7
相关论文
共 22 条
[1]   Prevalence of Nontuberculous Mycobacterial Lung Disease in US Medicare Beneficiaries [J].
Adjemian, Jennifer ;
Olivier, Kenneth N. ;
Seitz, Amy E. ;
Holland, Steven M. ;
Prevots, D. Rebecca .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2012, 185 (08) :881-886
[2]   Aging, COPD, and Other Risk Factors Do Not Explain the Increased Prevalence of Pulmonary Mycobacterium avium Complex in Ontario [J].
Al-Houqani, Mohammed ;
Jamieson, Frances ;
Mehta, Mauli ;
Chedore, Pamela ;
May, Kevin ;
Marras, Theodore K. .
CHEST, 2012, 141 (01) :190-197
[3]   The epidemiologic relationship between tuberculosis and non-tuberculous mycobacterial disease: a systematic review [J].
Brode, S. K. ;
Daley, C. L. ;
Marras, T. K. .
INTERNATIONAL JOURNAL OF TUBERCULOSIS AND LUNG DISEASE, 2014, 18 (11) :1370-1377
[4]   Mycobacterial infection: A difficult and late diagnosis in stem cell transplant recipients [J].
Cordonnier, C ;
Martino, R ;
Trabasso, P ;
Held, TK ;
Akan, H ;
Ward, MS ;
Fabian, K ;
Ullmann, AJ ;
Wulffraat, N ;
Ljungman, P ;
Alessandrino, EP ;
Pretnar, J ;
Gmur, J ;
Varela, R ;
Vitek, A ;
Sica, S ;
Rovira, M .
CLINICAL INFECTIOUS DISEASES, 2004, 38 (09) :1229-1236
[5]   National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report [J].
Filipovich, AH ;
Weisdorf, D ;
Pavletic, S ;
Socie, G ;
Wingard, JR ;
Lee, SJ ;
Martin, P ;
Chien, J ;
Przepiorka, D ;
Couriel, D ;
Cowen, EW ;
Dinndorf, P ;
Farrell, A ;
Hartzman, R ;
Henslee-Downey, J ;
Jacobsohn, D ;
McDonald, G ;
Mittleman, B ;
Rizzo, JD ;
Robinson, M ;
Schubert, M ;
Schultz, K ;
Shulman, H ;
Turner, M ;
Vogelsang, G ;
Flowers, MED .
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION, 2005, 11 (12) :945-956
[6]   Nontuberculous mycobacterial infections in hematopoietic stem cell transplant recipients: Characteristics of respiratory and catheter-related infections [J].
Gaviria, JM ;
Garcia, PJ ;
Garrido, SM ;
Corey, L ;
Boeckh, M .
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION, 2000, 6 (04) :361-369
[7]   An official ATS/IDSA statement: Diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases [J].
Griffith, David E. ;
Aksamit, Timothy ;
Brown-Elliott, Barbara A. ;
Catanzaro, Antonino ;
Daley, Charles ;
Gordin, Fred ;
Holland, Steven M. ;
Horsburgh, Robert ;
Huitt, Gwen ;
Iademarco, Michael F. ;
Iseman, Michael ;
Olivier, Kenneth ;
Ruoss, Stephen ;
von Reyn, C. Fordham ;
Wallace, Richard J., Jr. ;
Winthrop, Kevin .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2007, 175 (04) :367-416
[8]   Mycophenolate-based graft versus host disease prophylaxis is not inferior to methotrexate in myeloablative-related donor stem cell transplantation [J].
Hamad, Nada ;
Shanavas, Mohamed ;
Michelis, Fotios V. ;
Uhm, Jieun ;
Gupta, Vikas ;
Seftel, Matthew ;
Kuruvilla, John ;
Lipton, Jeffrey H. ;
Messner, Hans A. ;
Kim, Dennis .
AMERICAN JOURNAL OF HEMATOLOGY, 2015, 90 (05) :392-399
[9]   Investigation of the freely available easy-to-use software 'EZR' for medical statistics [J].
Kanda, Y. .
BONE MARROW TRANSPLANTATION, 2013, 48 (03) :452-458
[10]   Clinical significance of nontuberculous mycobacteria from respiratory specimens in stem cell transplantation recipients [J].
Kang, Ji Young ;
Ha, Jick Hwan ;
Kang, Hye Seon ;
Yoon, Hyoung-Kyu ;
Kim, Hee-Je ;
Lee, Seok ;
Lee, Dong-Gun ;
Jung, Jung Im ;
Kim, Seok Chan ;
Kim, Young Kyoon .
INTERNATIONAL JOURNAL OF HEMATOLOGY, 2015, 101 (05) :505-513