TABLE V.
Outcomes for all patients
| Outcome | Patients (n = 57) |
|---|---|
| Transplant-related mortality | 8 (14) |
| Infection* | 6 (11) |
| Organ toxicity (regimen-related) | 2 (4) |
| Acute GVHD | 22 (39) |
| Grade 2–4 | 13 (23) |
| Grade 3–4 | 4 (7) |
| Chronic GVHD† | 9 (16) |
| Mild | 3 (11) |
| Moderate | 1 (2) |
| Severe | 2 (4) |
| Organ toxicities | |
| Renal failure requiring dialysis‡ | 6 (11) |
| Sinusoidal obstructive syndrome§ | 3 (5) |
| Congestive heart failure | 3 (5) |
| ARDS | 3 (5) |
| Respiratory failure requiring ECMO§ | 2 (4) |
| DAH, IPS, BO, or COP | 0 |
| Infectious complications | |
| CMV infection requiring treatment; CMV disease | 26 (46); 4 (7) |
| EBV in blood requiring therapy; EBV-PTLD | 6 (11); 3 (5) |
| Adenoviremia requiring treatment; adenovirus with organ involvement | 4 (7); 1 (2) |
| HHV-6 in blood requiring treatment; HHV-6 encephalitis | 5 (9); 0 |
| BK virus-associated hemorrhagic cystitis; biopsy-proven BK nephropathy | 10 (18); 1 (2) |
| Lower respiratory viral infection other than CMV or adenovirus | 8 (14) |
| HSV requiring treatment | 6 (11) |
| VZV requiring treatment | 3 (5) |
| Bacteremia, with or without sepsis; sepsis | 19 (33); 9 (16) |
| Other significant bacterial infection | 10 (18) |
| Fungal infection requiring systemic treatment | 3 (5) |
| Pneumocystis jiroveci pneumonia | 1 (2) |
| Toxoplasmosis reactivation | 0 |
ARDS, Acute respiratory distress syndrome; BO, bronchiolitis obliterans; COP, cryptogenic organizing pneumonia; DAH, diffuse alveolar hemorrhage; ECMO, extracorporeal membranous oxygenation; HHV-6, human herpesvirus-6; HSV, herpes simplex virus; IPS, idiopathic pneumonia syndrome; PTLD, post-transplantation lymphoproliferative disease; VZV, varicella zoster virus.
Values are n or n (%).
Attributed to Pseudomonas aeruginosa (n = 3, at days +6, +238, +340), Rhizomucor pusillus (n = 1, day +17), sepsis in asplenic patient (n = 1, day +663), and CMV disease (n = 1, day +75). Only the last patient had active GVHD (grade 2, skin only) requiring systemic corticosteroids, diagnosed a week before death; 1 other patient had grade 2, skin only GVHD that developed following donor lymphocyte infusion for lymphoma relapse, treated with calcineurin inhibitor alone, but died of multidrug-resistant Pseudomonas.
Chronic skin GVHD without available data on severity reported for 3 patients. One patient had probable ocular-only chronic GVHD, not diagnostic of GVHD per 2014 consensus criteria and not included above.
Occurred in the setting of severe infection (n = 5), SOS, and thrombotic microangiopathy (n = 1). Three patients had significant known preexisting renal pathology. Two patients had concurrent respiratory failure requiring ECMO; outcomes included transplant-related mortality (n = 4) and chronic kidney disease (n = 2, focal segmental glomerulosclerosis on immunosuppression; BK-associated nephropathy requiring hemodialysis).
Developed following RIC in all 3 patients, 2 of whom had known prior known liver pathology (n = 2). The remaining patient, without prior known liver pathology, received 16 mg/kg total of busulfan, targeting area under the curve of 60 mg · h/L.