Infections in adults undergoing unrelated donor bone marrow transplantation

Br J Haematol. 1999 Mar;104(3):560-8. doi: 10.1046/j.1365-2141.1999.01229.x.


This study retrospectively reviews infections over a 7-year period in 60 consecutive adults (median age 25 years) undergoing their first unrelated donor bone marrow transplant (UD-BMT). T-cell depletion was employed in 93%. More than half the patients had one or more severe, potentially life-threatening, infections. There was a high incidence of invasive fungal infections (Aspergillus 17, Candida four), despite the use of itraconazole or amphotericin prophylaxis. Ten Aspergillus infections occurred beyond 100 d. Two patients (11%) with invasive aspergillosis survived. Clustering of infections was noted, with invasive fungal infections significantly associated with bacteraemias (OR 3.73, P=0.06) and multiple viral infections (OR 4.25, P=0.05). There were 21 severe viral infections in 16 patients, with CMV disease occurring in four patients only; viral pneumonitis was predominantly due to 'community respiratory' viruses. Most early bacteraemias (68%) were due to Gram-positive organisms. The majority of episodes of Gram-negative sepsis were caused by non-fastidious non-fermentative bacteria, such as Pseudomonas spp. and Acinetobacter spp., historically regarded as organisms of low pathogenicity. In patients with successful engraftment and minimal graft-versus-host disease, late infections suggestive of continued immune dysfunction (shingles, recurrent lower respiratory infections, Salmonella enteritis and extensive warts) were common.

MeSH terms

  • Adolescent
  • Adult
  • Bacteremia / etiology
  • Bone Marrow Transplantation / adverse effects*
  • Female
  • Graft Survival
  • Graft vs Host Disease / etiology
  • Hematologic Diseases / therapy
  • Humans
  • Male
  • Middle Aged
  • Mycoses / etiology
  • Opportunistic Infections / etiology*
  • Retrospective Studies
  • Tissue Donors
  • Virus Diseases / etiology