key: cord-0037913-jx8xbs9k
authors: Peterson, Shawn Lanham; Priddy, Erin; Dong, Brian Yang; Ghazi, Cameron Alexander; Dinglasan, Lu Anne Velayo
title: Evaluation of Infection Risk Factors in Adult Hematologic Malignancy Patients
date: 2019-01-31
journal: Biol Blood Marrow Transplant
DOI: 10.1016/j.bbmt.2018.12.562
sha: c8fb9775551babeae455eb48bba1724b58f23327
doc_id: 37913
cord_uid: jx8xbs9k

INTRODUCTION: Hematologic malignancies (HM) are often highly aggressive processes requiring multi-chemotherapy regimens and potentially hematopoietic stem cell transplant (HSCT) for treatment. Totally implantable venous access ports (TIVAP) are the standard access for administration of these regimens. The regimens usually involve periods of neutropenia for which infection can increase morbidity and require removal of the port. Although deemed safe for use in cancer populations, many studies have only looked at patients with TIVAP in solid tumor malignancies. Herein, we report our single institution experience identifying modulators for infection related to TIVAP in this high-risk population. OBJECTIVES: To identify risk factors for port infection in HM patients. METHODS: We performed an IRB-approved single institution retrospective review of HM patients who had a TIVAP removed for port infection versus completion of therapy. Medical records were evaluated for patient demographics and tumor type, details of previous therapy regimens such as chemotherapy and HSCT status, laboratory values including albumin, white blood cell, neutrophil and platelet counts, as well as characteristics of the TIVAP. Univariate and multivariate regression analyses were performed between the two cohorts to identify clinical predictors of port infection necessitating TIVAP removal. RESULTS: Between March 2015 and July 2018, 104 TIVAPs were removed from HM patients, 34 (33%) for infection and 70 (67%) for completion of treatment. Median patient age was 60 years (range 22-86) and there was an even number of men and women (n=52). Most TIVAPs were double lumen (n=98, 94%) and placed in the right IJV (n=100, 96%). The median number of port days was 49 in the infection group and 414 in the completion group, with removal of 12 (35%) of the infected ports within 30 days. Multiple factors were significant predictors of port infection on univariate analysis, including diagnosis of AML or ALL (p=0.0019), no prior HSCT (p=0.0148), neutropenia within 30 days of removal (p<0.0001), ANC <1500 (p <0.0001), leukopenia the day prior to removal (p<0.0001), thrombocytopenia (p <0.0001), and hypoalbuminemia (p<0.0001). Steroid use, leukopenia or leukocytosis the day of placement, and leukocytosis the day prior to removal were not significantly different between the two groups. On multivariate analysis, no prior HSCT (OR=48.08, 95% CI 2.64-875.63, p=0.009), neutropenia within 30 days of removal (OR=67.60, 95% CI 1.68-2726.66, p=0.026), and hypoalbuminemia (OR=405.52, 95% CI 15.64-10517.89, p<0.0001) remained significant. CONCLUSION: In patients with HM, significant predictors of port infection requiring TIVAP removal included neutropenia within 30 days of removal and hypoalbuminemia. Interestingly, patients who underwent HSCT were less likely to a develop a port infection requiring TIVAP removal.

Introduction: Respiratory infections after HCT lead to significant morbidity, mortality, and health care costs due to pulmonary complications. In up to a third of patients following allogeneic HCT, infection can progress from an upper to a lower respiratory tract infection. Without vaccines or effective therapeutics for most viruses, very little can be done beyond supportive care. Objectives: There is a need to identify risk factors for virus acquisition in HCT recipients in order to develop and implement better preventative interventions. Methods: In a prospective study, 471 HCT patients enrolled between 2005 and 2010 underwent weekly PCR-based surveillance for RSV, metapneumovirus, parainfluenza virus 1-4, influenza A and B, rhinovirus, coronavirus, and adenovirus. Detailed weekly surveys were collected from subjects for up to 1 year post-transplant on symptoms and exposures to children under 10 years or sick contacts (within 3 feet for more than 1 hour total in the past week). We performed multivariable Cox regression analysis to identify risk factors associated with the time to first positive respiratory viral detection by PCR (asymptomatic and symptomatic) within the first 100 days HCT. Results: In this cohort, 211 patients (45%) acquired a respiratory virus in the first 100 days after transplant. Of those infected, 88 (42%) were symptomatic with at least 2 respiratory symptoms. We found significantly higher risk of acquiring any respiratory viral infection for patients with underlying chronic leukemia compared with other hematologic malignancies [hazard ratio (HR) 1.79 (1.16 À 2.77)], exposure to children under or over 4 years [HR 1.84 (1.36 À 2.48)], exposure to contacts with cold symptoms [HR 1.47 (1.02 À 2.12)], exposure to systemic steroids [HR 1.49 (1.07 À 2.08)], and absolute monocyte counts < 100/mL [HR 1.81 (1.12 À 2.94)]. Age, age of child exposure, gender, smoking history, season, conditioning regimen, donor relationship, cell source, presence of acute GVHD, albumin level, total IgG level, lymphocyte counts, and neutrophil counts were not associated with risk for acquisition. We also analyzed the association of these same variables with the time to first positive respiratory viral detection with symptomatic respiratory disease. We found that exposure to children [HR 1.56 (1.03 À 2.35)] and exposure to steroids [HR 1.59 (1.01 À 2.52)] remained associated with acquisition of symptomatic respiratory viral infection. Conclusions: These data support the contribution of both exposure and immunologic determinants to the risk of respiratory viral acquisition with and without development of symptoms. Although many infections were asymptomatic, patients receiving steroids and those in close proximity to children may benefit from closer monitoring and counseling in the early post-transplant period. Introduction: Hematologic malignancies (HM) are often highly aggressive processes requiring multi-chemotherapy regimens and potentially hematopoietic stem cell transplant (HSCT) for treatment. Totally implantable venous access ports (TIVAP) are the standard access for administration of these regimens. The regimens usually involve periods of neutropenia for which infection can increase morbidity and require removal of the port. Although deemed safe for use in cancer populations, many studies have only looked at patients with TIVAP in solid tumor malignancies. Herein, we report our single institution experience identifying modulators for infection related to TIVAP in this high-risk population. Objectives: To identify risk factors for port infection in HM patients. Methods: We performed an IRB-approved single institution retrospective review of HM patients who had a TIVAP removed for port infection versus completion of therapy. Medical records were evaluated for patient demographics and tumor type, details of previous therapy regimens such as chemotherapy and HSCT status, laboratory values including albumin, white blood cell, neutrophil and platelet counts, as well as characteristics of the TIVAP. Univariate and multivariate regression analyses were performed between the two cohorts to identify clinical predictors of port infection necessitating TIVAP removal. Results: Between March 2015 and July 2018, 104 TIVAPs were removed from HM patients, 34 (33%) for infection and 70 (67%) for completion of treatment. Median patient age was 60 years (range 22-86) and there was an even number of men and women (n=52). Most TIVAPs were double lumen (n=98, 94%) and placed in the right IJV (n=100, 96%). The median number of port days was 49 in the infection group and 414 in the completion group, with removal of 12 (35%) of the infected ports within 30 days. Multiple factors were significant predictors of port infection on univariate analysis, including diagnosis of AML or ALL (p=0.0019), no prior HSCT (p=0.0148), neutropenia within 30 days of removal (p<0.0001), ANC <1500 (p <0.0001), leukopenia the day prior to removal (p<0.0001), thrombocytopenia (p <0.0001), and hypoalbuminemia (p<0.0001). Steroid use, leukopenia or leukocytosis the day of placement, and leukocytosis the day prior to removal were not significantly different between the two groups. On multivariate analysis, no prior HSCT (OR=48.08, 95% CI 2.64-875.63, p=0.009), neutropenia within 30 days of removal (OR=67.60, 95% CI 1.68-2726.66, p=0.026), and hypoalbuminemia (OR=405.52, 95% CI 15.64-10517.89, p<0.0001) remained significant. Conclusion: In patients with HM, significant predictors of port infection requiring TIVAP removal included neutropenia within 30 days of removal and hypoalbuminemia. Interestingly, patients who underwent HSCT were less likely to a develop a port infection requiring TIVAP removal.

Factors Associated with More Severe BK Hemorrhagic Cystitis in an Allogeneic Hematopoietic Cell Transplant Cohort Hannah Imlay MD 1,2 , Hu Xie MS 3 , Wendy M Leisenring PhD

Allergy and Infectious Disease