Infectious Complications After Umbilical Cord Blood Transplantation for Hematological Malignancy

Linder, Kathleen A; McDonald, Philip J; Kauffman, Carol A; Revankar, Sanjay G; Chandrasekar, Pranatharthi H; Miceli, Marisa H

Overall mortality in the first year post-UCBT was 56% (32 patients); 3 additional patients died in year 2. Thirteen of the 35 (37%) deaths were attributed to infection (Table 5) . Malignancy relapse occurred in 18 patients, and death from relapse occurred in 14, including the 3 patients who died in year 2. Other causes of death were complications of severe/ refractory GVHD in 5, sinusoidal obstruction syndrome in 1, graft failure in 1, and hemophagocytic lymphohistiocytosis in 1. The median time from UCBT to death from infection was 49 days (range, , and the median time to death from malignancy relapse was 223 days (range, 21-468) (P = .002). Among the 10 patients who never achieved neutrophil engraftment, 9 died within 100 days of UCBT, 6 of those from infection between days 18 and 52 post-UCBT. Seven of the 13 infections that led to death occurred in the first 30 days post-UCBT, and 4 patients who died developed infection between days 30 and 100 post-UCBT. Patients who died <100 days after UCBT (n = 17) had more early infections due to invasive fungi (P = .04), VRE (P = .03), and Enterobacteriaceae (P = .03) compared with those who survived more than 100 days after transplant (n = 40).