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Association of Cumulative Steroid Dose with Risk of Infection after Treatment for Severe Acute Graft-versus-Host Disease

2016; Elsevier BV; Volume: 22; Issue: 6 Linguagem: Inglês

10.1016/j.bbmt.2016.02.020

1523-6536

Yayoi Matsumura‐Kimoto, Yoshihiro Inamoto, Kinuko Tajima, Akihisa Kawajiri, Takashi Tanaka, Tsuneaki Hirakawa, Kazuko Ino, Yu Asao, Hiroyuki Tamogami, Chika Kono, Wataru Takeda, Keiji Okinaka, Shigeo Fuji, Saiko Kurosawa, Sung Won Kim, Ryuji Tanosaki, Takuya Yamashita, Takahiro Fukuda,

Hematopoietic Stem Cell Transplantation

Highlights•Invasive fungal disease was common (14%) after steroid therapy for severe graft-versus-host disease•Viral disease was common (∼25%) after steroid therapy for severe graft-versus-host disease•Gram-negative rod infection was common (20%) after steroid therapy for severe graft-versus-host disease•Graft-versus-host disease within 26 days and low lymphocyte count correlated with risk of infection•Cumulative steroid doses correlated with risks of fungal and viral diseasesAbstractThis study aimed to characterize the incidence and risk factors of invasive fungal disease, cytomegalovirus infection, other viral diseases, and gram-negative rod infection after glucocorticoid treatment for severe acute graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation and to elucidate the associations of cumulative steroid dose with the risks of individual infections. The study cohort included 91 consecutive patients who developed maximum grades III and IV acute GVHD at our center. The mean cumulative prednisolone-equivalent dose was 41 mg/kg during the first 4 weeks. The cumulative incidence rates of fungal disease, cytomegalovirus disease, other viral diseases, and gram-negative rod infection at 6 months after glucocorticoid treatment were remarkably high, at 14%, 21%, 28%, and 20%, respectively. GVHD within 26 days after transplantation and low lymphocyte count at GVHD treatment were associated with increased risks of several infections. Cumulative prednisolone-equivalent steroid doses ≥ 55 mg/kg during the first 4 weeks were associated with an increased risk of fungal disease (hazard ratio, 3.65; P = .03) and cumulative doses ≥ 23 mg/kg were associated with an increased risk of non-cytomegalovirus viral diseases (hazard ratio, 4.14; P = .02). Strategies to reduce the risk of infectious complications are needed, particularly for patients who have risk factors and those who receive high cumulative steroid doses.