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Amer R, Salameh H, Mosleh S, Abu-Taha A, Hamayel H, Enaya A, Adas A, Khursani A, Wild-Ali M, Mousa T, Battat M, Daifallah A, Koni A, Shawahna R. Epidemiology of early infections and predictors of mortality after autologous hematopoietic stem-cell transplantation among multiple myeloma, Hodgkin, and non-Hodgkin lymphoma: the first experience from Palestine. BMC Infect Dis 2022; 22:725. [PMID: 36071381 PMCID: PMC9449926 DOI: 10.1186/s12879-022-07709-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/26/2022] [Indexed: 12/24/2022] Open
Abstract
Background Autologous hematopoietic stem-cell transplantation (HSCT) is the standard of care in many relapsed and refractory lymphoid malignancy, neuroblastoma, and multiple myeloma (MM). This study was conducted to describe the epidemiology of early infections that occurred within the first 100 days among patients who received HSCT for MM, Hodgkin (HL), and non-Hodgkin lymphoma (NHL) in Palestine. Methods This study was conducted in a retrospective cohort design in the only autologous HSCT in Palestine in the period between 2014 and 2021. The medical records of the patients were reviewed to identify and collect demographic, clinical, and microbiological data on bacterial, viral, fungal, and parasitic infections as diagnosed by cultures, polymerase chain reaction, and fluorescent antibody testing. Results A total of 145 patients were included in this study (median age = 44.0 [28.0, 53.5] years). Of those, 8 (5.5%) were younger than 18 years, 69 (47.6%) had MM, 53 (36.6%) had HL, and 23 (15.9%) had NHL. The source of fever had no focus in the majority of the cases 82 (56.6%), 12 (8.3%) had bloodstream infections, 8 (5.5%) had colitis, and 7.6 (5.0%) had pneumonia. Patients from whom gram-negative bacteria were isolated stayed in the hospital for longer duration compared to the other patients (median = 21.0 [19.0, 25.0] vs. 18.0 [15.0, 22.0] days, p-value = 0.043, respectively). The cumulative incidence of death in the first 100 days after infusion of stem cells was 3.4%. The cumulative incidence of death in the first 100 days post-transplantation was higher for patients with NHL compared to those with HL and MM (p-value = 0.017). Gram-negative and fungal infections were strong predictors of mortality. Conclusion Bacterial gram-positive and gram-negative infections were the most common early infections among patients who underwent autologous HSCT for hematological malignancies (HM) in the only center in Palestine. The findings of this study are informative to healthcare providers and planners of care for patients who are scheduled to receive autologous HSCT for HM. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07709-4.
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Affiliation(s)
- Riad Amer
- Department of Medicine, An-Najah National University Hospital, P.O. Box 7, Nablus, Palestine. .,Hematology and Oncology, An-Najah National University Hospital, Nablus, Palestine.
| | - Husam Salameh
- Department of Medicine, An-Najah National University Hospital, P.O. Box 7, Nablus, Palestine. .,Hematology and Oncology, An-Najah National University Hospital, Nablus, Palestine.
| | - Sultan Mosleh
- Department of Medicine, An-Najah National University Hospital, P.O. Box 7, Nablus, Palestine.,Hematology and Oncology, An-Najah National University Hospital, Nablus, Palestine
| | - Adham Abu-Taha
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Hamza Hamayel
- Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Ahmad Enaya
- Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Amro Adas
- Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Ahmad Khursani
- Hematology and Oncology, An-Najah National University Hospital, Nablus, Palestine
| | - Mohamad Wild-Ali
- Hematology and Oncology, An-Najah National University Hospital, Nablus, Palestine
| | - Taghreed Mousa
- Hematology and Oncology, An-Najah National University Hospital, Nablus, Palestine
| | - Maher Battat
- Hematology and Oncology, An-Najah National University Hospital, Nablus, Palestine
| | - Aiman Daifallah
- Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Amer Koni
- Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Ramzi Shawahna
- Department of Physiology, Pharmacology and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.,An-Najah BioSciences Unit, Centre for Poisons Control, Chemical and Biological Analyses, An-Najah National University, Nablus, Palestine
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Moghnieh R, Tamim H, Abyad A, Jadayel M, Awad L, Abdallah D, Haddad N, Berberi J, Alwazir R, Taher R, Jisr T, Lakkis R, Zahran K, Ibrahim A. Pre-engraftment infectious complications and patient outcomes after allogeneic hematopoietic cell transplantation: a single-center experience from Lebanon. Infection 2020; 48:385-401. [PMID: 32170652 DOI: 10.1007/s15010-020-01407-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/02/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Infectious complications are significant causes of morbidity and mortality after allogeneic hematopoietic cell transplantation (allo-HCT). They occur variably over different periods, with scant data reported from Lebanon and neighboring countries. In this study, we described the pre-engraftment neutropenic phase, febrile episodes, and peri-transplant medical complications in patients undergoing allo-HCT at a tertiary-care hospital. METHODS This is a retrospective chart review of patients who underwent allo-HCT between 2007 and 2016 at Makassed General Hospital in Beirut, Lebanon. Data were extracted from medical records, the HCT registry, and medical laboratory logbooks. RESULTS One hundred and six patients were included, 75% having hematologic malignancies and 13% aplastic anemia. None received antibacterial prophylaxis with fluoroquinolones. Yet from conditioning chemotherapy till the say before HCT, 32% of the patients received broad-spectrum antibiotics (BSA) due to fever or infection. At the day of cell infusion, 41.5% of the patients were on BSA. Neutrophil engraftment failure was recorded in 8% of the patients. The cumulative incidence of pre-engraftment bacteremia and Gram-negative bacteremia was 14.3 and 7.1%, respectively. Aplastic anemia was an independent risk factor for pre-engraftment bacteremia [hazard ratio (HR) = 3.86, 95% confidence interval (CI) (1.29-11.5), P = 0.02]. The cumulative incidence of pre-engraftment pneumonia was 11.2%. Patient age significantly increased the risk of pre-engraftment pneumonia [HR = 12.35, 95% CI (1.27-120.50), P = 0.03]. Six-month post-transplant mortality reached 17% in our cohort. Myelodysplastic syndrome was the only significant parameter increasing the risk of death [HR = 3.40, 95% CI (1.05-10.98), P = 0.04]. CONCLUSION The cumulative incidence of pre-engraftment bacteremia and pneumonia was 14.3% and 11.2% respectively in this cohort. Aplastic anemia predicted for the occurrence of bacteremia, increasing patient age contributed to the occurrence of pneumonia, and myelodysplastic syndrome increased the risk of death.
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Affiliation(s)
- Rima Moghnieh
- Division of Infectious Diseases, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon. .,Division of Infectious Diseases, Department of Internal Medicine, Hôtel Dieu de France, Beirut, Lebanon.
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Amin Abyad
- Division of Hematology/Oncology, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Marwa Jadayel
- School of Pharmacy, Beirut Arab University, Beirut, Lebanon
| | - Lyn Awad
- Pharmacy Department, Makassed General Hospital, Beirut, Lebanon
| | - Dania Abdallah
- Pharmacy Department, Makassed General Hospital, Beirut, Lebanon
| | - Nicholas Haddad
- Infectious Disease and Residency Program, Internal Medicine, Central Michigan University, Saginaw, MI, 48602, USA
| | | | - Rawya Alwazir
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Rida Taher
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | - Tamima Jisr
- Department of Laboratory Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Rawad Lakkis
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Kamal Zahran
- Division of Hematology/Oncology, Middle East Institute of Health, Bsalim, Lebanon
| | - Ahmad Ibrahim
- Division of Hematology/Oncology, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
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