• Karen Ballen, Woo AhnKwangKCenter for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, W, Min Chen, Hisham Abdel-Azim, Ibrahim Ahmed, Mahmoud Aljurf, Joseph Antin, Ami S Bhatt, Michael Boeckh, George Chen, Christopher Dandoy, Biju George, Mary J Laughlin, Hillard M Lazarus, Margaret L MacMillan, David A Margolis, David I Marks, Maxim Norkin, Joseph Rosenthal, Ayman Saad, Bipin Savani, Harry C Schouten, Jan Storek, Paul Szabolcs, Celalettin Ustun, Michael R Verneris, Edmund K Waller, Daniel J Weisdorf, Kirsten M Williams, John R Wingard, Baldeep Wirk, Tom Wolfs, YoungJo-Anne HJHDivision of Blood and Marrow Transplantation, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota., Jeffrey Auletta, Krishna V Komanduri, Caroline Lindemans, and Marcie L Riches.
• Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: kballen@partners.org.
• Biol. Blood Marrow Transplant. 2016 Sep 1; 22 (9): 1636-1645.

AbstractAlternative graft sources (umbilical cord blood [UCB], matched unrelated donors [MUD], or mismatched unrelated donors [MMUD]) enable patients without a matched sibling donor to receive potentially curative hematopoietic cell transplantation (HCT). Retrospective studies demonstrate comparable outcomes among different graft sources. However, the risk and types of infections have not been compared among graft sources. Such information may influence the choice of a particular graft source. We compared the incidence of bacterial, viral, and fungal infections in 1781 adults with acute leukemia who received alternative donor HCT (UCB, n= 568; MUD, n = 930; MMUD, n = 283) between 2008 and 2011. The incidences of bacterial infection at 1 year were 72%, 59%, and 65% (P < .0001) for UCB, MUD, and MMUD, respectively. Incidences of viral infection at 1 year were 68%, 45%, and 53% (P < .0001) for UCB, MUD, and MMUD, respectively. In multivariable analysis, bacterial, fungal, and viral infections were more common after either UCB or MMUD than after MUD (P < .0001). Bacterial and viral but not fungal infections were more common after UCB than MMUD (P = .0009 and <.0001, respectively). The presence of viral infection was not associated with an increased mortality. Overall survival (OS) was comparable among UCB and MMUD patients with Karnofsky performance status (KPS) ≥ 90% but was inferior for UCB for patients with KPS < 90%. Bacterial and fungal infections were associated with poorer OS. Future strategies focusing on infection prevention and treatment are indicated to improve HCT outcomes.Copyright © 2016 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

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