Early blood stream infection as a risk factor for acute GVHD in children

What is it about?

Graft-versus-host disease (GVHD) remains a major cause of mortality and morbidity in allogeneic hematopoietic stem cell transplantation (HSCT). In adults, early blood stream infection (BSI) and acute GVHD have been reported to be related. The impact of BSI on risk for acute GVHD, however, has not been assessed in pediatric patients. In this paper, we conducted a retrospective analysis to test the hypothesis that early BSI (before day +30) predisposes allogeneic pediatric transplant patients to severe acute GVHD. We analyzed 293 allogeneic HSCT performed at Children’s Healthcare of Atlanta between 2005 and 2014 that met eligibility criteria.

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Why is it important?

The cumulative incidence of acute grade III-IV GVHD at 100 days after HSCT was 17.1%. In multivariate analysis, risk for acute grade III-IV GVHD was associated with donor source other than matched-related donor (hazard ratio (HR) =7.710, P<0.001), and BSI between day 0 and +30 prior to acute GVHD (HR=2.790, P=0.003). The results of our study highlight the importance of early BSI as the risk factor for severe acute GVHD, not previously considered in children and adolescents. Our results further suggest that only mucosal barrier injury-associated BSI is related to severe acute GVHD. In the adult study, it was not studied whether the incidence of acute GVHD differs depending on the types of bacteria identified in blood culture.

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