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Pretransplant neutropenia is associated with poor-risk cytogenetic features and increased infection-related mortality in patients with myelodysplastic syndromes.

Scott, Bart L and Park, J Y and Deeg, H Joachim and Marr, Kieren A and Boeckh, Michael and Chauncey, Thomas R and Appelbaum, Frederick R and Storb, Rainer and Storer, Barry E (2008) Pretransplant neutropenia is associated with poor-risk cytogenetic features and increased infection-related mortality in patients with myelodysplastic syndromes. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, 14 (7). pp. 799-806. ISSN 1523-6536

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Abstract

A retrospective cohort analysis was performed to determine the impact of neutropenia on the outcome of hematopoietic cell transplantation (HSCT) in patients with myelodysplasia (MDS). Among 291 consecutive patients, 178 (61%) had absolute neutrophil counts (ANCs) <1500/microL and 113 (39%) had ANCs > or =1500/microL within 2 weeks before HSCT. Neutropenic patients more often had poor-risk karyotypes (34% versus 12%, P < .0001) and high-risk International Prognostic Scoring System scores (37% versus 18%, P = .0006). After HSCT, the rate of infections caused by Gram-positive bacteria and invasive fungal infections was significantly increased among neutropenic patients (rate ratio [RR] 1.77, P = .02 and RR = 2.56, P = .03, respectively), whereas infections caused by Gram-negative bacteria were not affected (RR 1.33, P = .53). The hazards of nonrelapse mortality (NRM) (hazard ratio [HR] = 1.62 [1.1-2.4], P = .01), overall mortality (HR = 1.55 [1.1-2.1], P = 0.007), and infection-related mortality (HR = 2.22 [1.2-4.2], P = .01) were increased in neutropenic patients, whereas relapse, engraftment, and graft-versus-host-disease were not affected. After adjusting for cytogenetic risk and marrow myeloblast percentages, neutropenic patients remained at significant hazard for infection-related mortality (HR = 1.94 [1.0-3.8], P = .05), but not for overall mortality or NRM. We propose that intensified strategies to prevent infections should be implemented in MDS patients with preexisting neutropenia who undergo HSCT.

Item Type: Article
DOI: 10.1016/j.bbmt.2008.04.011
PubMed ID: 18541200
NIHMSID: NIHMS55739
PMCID: PMC2587376
Other ID: RM1256,rs12
Grant Numbers: HL084054, HL36444, CA18029, CA15704, HL82941
Keywords or MeSH Headings: Adolescent Adult Aged Bacterial Infections/etiology* Child Child, Preschool Cohort Studies Cross Infection/etiology Female Hematopoietic Stem Cell Transplantation/adverse effects* Humans Infant Male Middle Aged Mycoses/etiology* Myelodysplastic Syndromes/complications* Myelodysplastic Syndromes/therapy* Neutropenia/complications* Odds Ratio Retrospective Studies Survival Analysis
Subjects: Diseases > Bacterial and fungal diseases
Cell Types > Blood and Immune Cells
Therapeutics > Transplantation > Stem Cell transplantation
Diseases > Hematologic and lymphatic diseases > Myelodysplastic syndrome
Depositing User: Library Staff
Date Deposited: 14 Aug 2008 22:27
Last Modified: 02 Mar 2012 21:37
URI: http://authors.fhcrc.org/id/eprint/11

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