Association of Cumulative Steroid Dose with Risk of Infection after Treatment for Severe Acute Graft-versus-Host Disease

Yayoi Matsumura-Kimoto, Yoshihiro Inamoto, Kinuko Tajima, Akihisa Kawajiri, Takashi Tanaka, Tsuneaki Hirakawa, Kazuko Ino, Yu Asao, Hiroyuki Tamogami, Chika Kono, Wataru Takeda, Keiji Okinaka, Shigeo Fuji, Saiko Kurosawa, Sung Won Kim, Ryuji Tanosaki, Takuya Yamashita, Takahiro Fukuda

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15 Citations (Scopus)

Abstract

This study aimed to characterize the incidence and risk factors of invasive fungal disease, cytomegalovirus infection, other viral diseases, and gram-negative rod infection after glucocorticoid treatment for severe acute graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation and to elucidate the associations of cumulative steroid dose with the risks of individual infections. The study cohort included 91 consecutive patients who developed maximum grades III and IV acute GVHD at our center. The mean cumulative prednisolone-equivalent dose was 41 mg/kg during the first 4 weeks. The cumulative incidence rates of fungal disease, cytomegalovirus disease, other viral diseases, and gram-negative rod infection at 6 months after glucocorticoid treatment were remarkably high, at 14%, 21%, 28%, and 20%, respectively. GVHD within 26 days after transplantation and low lymphocyte count at GVHD treatment were associated with increased risks of several infections. Cumulative prednisolone-equivalent steroid doses ≥ 55 mg/kg during the first 4 weeks were associated with an increased risk of fungal disease (hazard ratio, 3.65; P = .03) and cumulative doses ≥ 23 mg/kg were associated with an increased risk of non-cytomegalovirus viral diseases (hazard ratio, 4.14; P = .02). Strategies to reduce the risk of infectious complications are needed, particularly for patients who have risk factors and those who receive high cumulative steroid doses.

Original languageEnglish
Pages (from-to)1102-1107
Number of pages6
JournalBiology of Blood and Marrow Transplantation
Volume22
Issue number6
DOIs
Publication statusPublished - 2016 Jun 1
Externally publishedYes

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Keywords

  • Adenovirus
  • Cytomegalovirus
  • Fungal infection
  • Graft-versus-host disease
  • Hematopoietic cell transplantation
  • Steroid dose

ASJC Scopus subject areas

  • Transplantation
  • Hematology

Cite this

Matsumura-Kimoto, Y., Inamoto, Y., Tajima, K., Kawajiri, A., Tanaka, T., Hirakawa, T., Ino, K., Asao, Y., Tamogami, H., Kono, C., Takeda, W., Okinaka, K., Fuji, S., Kurosawa, S., Kim, S. W., Tanosaki, R., Yamashita, T., & Fukuda, T. (2016). Association of Cumulative Steroid Dose with Risk of Infection after Treatment for Severe Acute Graft-versus-Host Disease. Biology of Blood and Marrow Transplantation, 22(6), 1102-1107. https://doi.org/10.1016/j.bbmt.2016.02.020