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Frontiers of Medicine

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Front. Med.    2022, Vol. 16 Issue (6) : 957-968    https://doi.org/10.1007/s11684-021-0910-1
RESEARCH ARTICLE
Risk stratification system for skin and soft tissue infections after allogeneic hematopoietic stem cell transplantation: PAH risk score
Shan Chong, Yun He, Yejun Wu, Peng Zhao, Xiaolu Zhu, Fengrong Wang, Yuanyuan Zhang, Xiaodong Mo, Wei Han, Jingzhi Wang, Yu Wang, Huan Chen, Yuhong Chen, Xiangyu Zhao, Yingjun Chang, Lanping Xu, Kaiyan Liu, Xiaojun Huang, Xiaohui Zhang()
Peking University People’s Hospital, Peking University Institute of Hematology, Beijing 100044, China; Collaborative Innovation Center of Hematology, Peking University, Beijing 100044, China; Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing 100044, China; National Clinical Research Center for Hematologic Disease, Beijing 100044, China
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Abstract

Skin and soft tissue infections (SSTIs) refer to infections involving the skin, subcutaneous tissue, fascia, and muscle. In transplant populations with hematological malignancies, an immunocompromised status and the routine use of immunosuppressants increase the risk of SSTIs greatly. However, to date, the profiles and clinical outcomes of SSTIs in hematopoietic stem cell transplantation (HSCT) patients remain unclear. This study included 228 patients (3.67%) who developed SSTIs within 180 days after allogeneic HSCT from January 2004 to December 2019 in Peking University People’s Hospital. The overall annual survival rate was 71.5%. We compared the differences between survivors and non-survivors a year after transplant and found that primary platelet graft failure (PPGF), comorbidities of acute kidney injury (AKI), and hospital-acquired pneumonia (HAP) were independent risk factors for death in the study population. A PPGF–AKI–HAP risk stratification system was established with a mortality risk score of 1×PPGF+1×AKI+1×HAP. The areas under the curves of internal and external validation were 0.833 (95% CI 0.760–0.906) and 0.826 (95% CI 0.715–0.937), respectively. The calibration plot revealed the high consistency of the estimated risks, and decision curve analysis showed considerable net benefits for patients.
Keywords skin and soft tissue infections      hematopoietic stem cell transplantation      risk stratification system      mortality     
Corresponding Author(s): Xiaohui Zhang   
Just Accepted Date: 15 June 2022   Online First Date: 03 November 2022    Issue Date: 16 January 2023
 Cite this article:   
Shan Chong,Yun He,Yejun Wu, et al. Risk stratification system for skin and soft tissue infections after allogeneic hematopoietic stem cell transplantation: PAH risk score[J]. Front. Med., 2022, 16(6): 957-968.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-021-0910-1
https://academic.hep.com.cn/fmd/EN/Y2022/V16/I6/957
Fig.1  Flow chart of the study population selection.
ICD diagnosis ICD code No. of patients (%)
Anogenital herpesvirus (herpes simplex) infection A60.XXX 3 (1.3)
Viral infections characterized by skin and mucous membrane lesions B00.XXX–B09.XXX 20 (8.8)
Dermatophytosis B35.XXX 2 (0.88)
Candidiasis of skin and nail B37.201 2 (0.88)
Anal abscess K61.002 13 (5.7)
Perianal infection K62.805 22 (9.6)
Cutaneous abscess, furuncle, and carbuncle L02.XXX 4 (1.8)
Cellulitis L03.XXX 13 (5.7)
Other local infections of skin and subcutaneous tissue L08.XXX 110 (48.2)
Decubitus ulcer L89.XXX 3 (1.3)
Gangrene R02.XXX 1 (0.4)
Infection and inflammatory reaction due to vascular devices T82.703 28 (12.3)
Infection following a procedure, not elsewhere classified T81.XXX 2 (0.88)
Tab.1  ICD-10 diagnosis and code of SSTIs in allo-HSCT recipients
Characteristics Survivors Non-survivors P
No. of patients 167 61
Gender, n (%) 0.980
Male 118 (70.7%) 43 (70.5%)
Female 49 (29.3%) 18 (29.5%)
Age (diagnosed with pneumonia), year, mean ± SD 32.68 ± 13.733 38.28 ± 12.731 0.006*
Underlying diseases, n (%) 0.467
AML 53 (31.7%) 16 (26.2%)
ALL 71 (42.5%) 27 (44.3%)
CML 9 (5.4%) 1 (1.6%)
MDS 27 (16.2%) 11 (18.0%)
NHL 2 (1.2%) 2 (3.3%)
Others 5 (3.0%) 4 (6.6%)
HCT-CI, n (%) 0.316
0 130 (77.8%) 46 (75.4%)
1 29 (17.4%) 8 (13.1%)
2 6 (3.6%) 6 (9.8%)
3 2 (1.2%) 1 (1.6%)
Median time from diagnosis to HSCT, month (range) 6 (2–144) 6 (2–240) 0.863
Disease status, n (%) 0.032*
CR 137 (82.0%) 42 (68.9%)
Advanced disease 30 (18.0%) 19 (31.1%)
Donor, n (%) 0.232
MRD 4 (2.4%) 2 (3.3%)
MUD 43 (25.7%) 15 (24.6%)
HID 119 (71.3%) 41 (67.2%)
CB 1 (0.6%) 3 (4.9%)
Gender relationship, n (%) 0.874
M−M 78 (46.7%) 33 (54.1%)
M−F 38 (22.8%) 11 (18.0%)
F−M 37 (22.2%) 12 (19.7%)
F−F 14 (8.4%) 5 (8.2%)
ABO compatibility, n (%) 0.467
Match 102 (61.1%) 34 (55.7%)
Mismatch 66 (38.9%) 27 (44.3%)
HLA compatibility, n (%) 0.433
Match 47 (28.1%) 17 (23.0%)
Haplo-identical 120 (71.9%) 44 (77.0%)
Graft source 0.149
BM + PB 158 (94.6%) 56 (91.8%)
BM 2 (1.2%) 0
PB 6 (3.6%) 2 (3.3%)
CB 1 (0.6%) 3 (4.9%)
MNCs ( × 108/kg, mean ± SD) 8.21 ± 1.67 8.04 ± 1.72 0.481
CD34+( × 106/kg, mean ± SD) 2.67 ± 1.37 2.79 ± 1.46 0.558
Median WBC engraftment time, day (range)a 14 (10–28) 14 (9–23) 0.361
Median PLT engraftment time, day (range)b 16 (6–170) 15 (10–153) 0.684
Antecedent aGVHD, n (%) 0.040*
None 151 (90.4%) 47 (77.0%)
I–II 11 (6.6%) 9 (14.8%)
III–IV 5 (3.0%) 5 (8.2%)
Antecedent cGVHD, n (%) 3 (1.8%) 3 (4.9%) 0.403
Antecedent CMV viremia 27 (16.2%) 14 (23%) 0.238
Antecedent EBV viremia 4 (2.4%) 2 (3.3%) 0.718
Tab.2  Baseline characteristics of surviving and dead allo-HSCT patients with SSTI
Locations of SSTIs No. of patients (%)
Maxillofacial infection 47 (20.6%)
Infection due to vascular devices 41 (18.0%)
Anal infection 40 (17.5%)
Lower limbs infection 29 (12.7%)
Upper limbs infection 11 (4.8%)
Back infection 11 (4.8%)
External genital infection 9 (3.9%)
Front trunk infection 9 (3.9%)
Hip infection 8 (3.5%)
Hands infection 8 (3.5%)
Feet infection 8 (3.5%)
Neck infection 3 (1.3%)
Perineum infection 2 (0.9%)
Multiple systemic infections 2 (0.9%)
Tab.3  Anatomic profiles of SSTIs in patients following allo-HSCT
Features Univariate Multivariate
OR 95% CI P OR 95% CI P
Age > 60 years 0.897 0.091–8.862 0.926
Disease status 1.852 0.832–4.118 0.131
History of diabetes mellitus, n (%) 3.565 1.125–11.298 0.031* 4.250 0.914–19.766 0.065
ABO matched 1.189 0.588–2.403 0.630
HLA matched 1.146 0.489–2.686 0.754
Primary platelet graft failure 24.348 7.606–77.941 < 0.001* 11.726 3.202–42.941 < 0.001*
CMV viremia 1.244 0.497–3.116 0.641
EBV viremia 2.227 0.582–8.911 0.237
aGVHD 1.960 0.877–4.382 0.101 1.216 0.474–3.120 0.685
cGVHD 5.610 0.495–63.516 0.164
SSTIs at multiple locations 0.940 0.317–2.788 0.911
Complicated SSTIs 2.135 0.457–9.965 0.335
Hospital-acquired pneumonia 11.667 5.140–26.479 < 0.001* 5.765 2.223–14.952 < 0.001*
Hepatic failure 19.594 4.130–92.947 < 0.001* 6.116 0.858–43.594 0.071
Acute kidney injury 12.948 3.405–49.230 < 0.001* 9.948 2.040–48.512 0.004*
Tab.4  Risk factors of the death of HSCT recipients with SSTI in the derivation cohort
Variables Multivariable analysis Point
OR (95% CI) P 　　Coefficients
Primary platelet graft failure 9.849 (3.293–29.459) < 0.001 　　2.462 1
Acute kidney injury 10.618 (3.093–36.455) 0.004 　　2.397 1
Hospital-acquired pneumonia 6.654 (3.015–14.682) < 0.001 　　1.752 1
Tab.5  Coefficients and points for the PAH risk stratification system for SSTIs in allo-HSCT recipients by using independent variables in the derivation cohort
Derivation cohort (n = 159) Validation cohort (n = 69)
Low Intermediate High Low Intermediate High
Risk score 0 1 2–3 0 1 2–3
Survivor 97 17 3 43 7 1
Non-survivor 9 15 19 4 9 5
Mortality 8.5% 46.9% 86.4% 8.5% 56.3% 83.3%
Tab.6  Mortality of allo-HSCT recipients with SSTIs in derivation and validation cohorts
Fig.2  Receiver operating characteristic (ROC) curve of the PAH risk stratification system in the derivation and validation cohorts. (A) ROC curve of the PAH risk stratification system for the derivation cohort. The area under the curve (AUC) was 0.833 (95% CI 0.760–0.906). (B) ROC curve of the PAH risk stratification system for the validation cohort. The AUC was 0.826 (95% CI 0.715–0.937).
Fig.3  Calibration plot of the PAH risk stratification system in the derivation and validation cohorts. (A) Calibration plot of the PAH risk stratification system for the derivation cohort. (B) Calibration plot of the PAH risk stratification system for the validation cohort. The x-axis plots the predicted one-year mortality of allo-HSCT recipients with SSTIs; the y-axis plots the observed one-year mortality in our study. The 45° diagonal line stands for the ideal calibration plot.
Fig.4  Decision curve analysis of the PAH stratification system in derivation and validation cohorts. (A) Decision curve analysis of the PAH risk stratification system for the derivation cohort. (B) Decision curve analysis of the PAH risk stratification system for the validation cohort. Black line: assuming no patient died within one year. Gray line: assuming all patients died within one year. The two lines serve as references.
1 Y Shono, MRM van den Brink. Gut microbiota injury in allogeneic haematopoietic stem cell transplantation. Nat Rev Cancer 2018; 18(5): 283–295
https://doi.org/10.1038/nrc.2018.10 pmid: 29449660
2 DP Lu, L Dong, T Wu, XJ Huang, MJ Zhang, W Han, H Chen, DH Liu, ZY Gao, YH Chen, LP Xu, YC Zhang, HY Ren, D Li, KY Liu. Conditioning including antithymocyte globulin followed by unmanipulated HLA-mismatched/haploidentical blood and marrow transplantation can achieve comparable outcomes with HLA-identical sibling transplantation. Blood 2006; 107(8): 3065–3073
https://doi.org/10.1182/blood-2005-05-2146 pmid: 16380454
3 R Zeiser, BR Blazar. Acute graft-versus-host disease—biologic process, prevention, and therapy. N Engl J Med 2017; 377(22): 2167–2179
https://doi.org/10.1056/NEJMra1609337 pmid: 29171820
4 S Naymagon, L Naymagon, SY Wong, HM Ko, A Renteria, J Levine, JF Colombel, J Ferrara. Acute graft-versus-host disease of the gut: considerations for the gastroenterologist. Nat Rev Gastroenterol Hepatol 2017; 14(12): 711–726
https://doi.org/10.1038/nrgastro.2017.126 pmid: 28951581
5 A Gratwohl, R Brand, F Frassoni, V Rocha, D Niederwieser, P Reusser, H Einsele, C; Acute Cordonnier, Leukemia Working Parties; Infectious Diseases Working Party of the European Group for Blood Chronic, Transplantation Marrow. Cause of death after allogeneic haematopoietic stem cell transplantation (HSCT) in early leukaemias: an EBMT analysis of lethal infectious complications and changes over calendar time. Bone Marrow Transplant 2005; 36(9): 757–769
https://doi.org/10.1038/sj.bmt.1705140 pmid: 16151426
6 M Sartelli, MA Malangoni, AK May, P Viale, LS Kao, F Catena, L Ansaloni, EE Moore, FA Moore, AB Peitzman, R Coimbra, A Leppaniemi, Y Kluger, W Biffl, K Koike, M Girardis, CA Ordonez, M Tavola, M Cainzos, Saverio S Di, GP Fraga, I Gerych, MD Kelly, K Taviloglu, I Wani, S Marwah, M Bala, W Ghnnam, N Shaikh, O Chiara, MP Jr Faro, GA Jr Pereira, CA Gomes, F Coccolini, C Tranà, D Corbella, P Brambillasca, Y Cui, Lohse HA Segovia, V Khokha, KY Kok, SK Hong, KC Yuan. World Society of Emergency Surgery (WSES) guidelines for management of skin and soft tissue infections. World J Emerg Surg 2014; 9(1): 57
https://doi.org/10.1186/1749-7922-9-57 pmid: 25422671
7 M Sartelli, X Guirao, TC Hardcastle, Y Kluger, MA Boermeester, K Raşa, L Ansaloni, F Coccolini, P Montravers, FM Abu-Zidan, M Bartoletti, M Bassetti, O Ben-Ishay, WL Biffl, O Chiara, M Chiarugi, R Coimbra, Rosa FG De, Simone B De, Saverio S Di, M Giannella, G Gkiokas, V Khokha, FM Labricciosa, A Leppäniemi, A Litvin, EE Moore, I Negoi, L Pagani, M Peghin, E Picetti, T Pintar, G Pupelis, I Rubio-Perez, B Sakakushev, H Segovia-Lohse, G Sganga, V Shelat, M Sugrue, A Tarasconi, C Tranà, J Ulrych, P Viale, F Catena. 2018 WSES/SIS-E consensus conference: recommendations for the management of skin and soft-tissue infections. World J Emerg Surg 2018; 13: 58
https://doi.org/10.1186/s13017-018-0219-9 pmid: 30564282
8 SA Fritz, DJ Shapiro, AL Hersh. National trends in incidence of purulent skin and soft tissue infections in patients presenting to ambulatory and emergency department settings, 2000–2015. Clin Infect Dis 2020; 70(12): 2715–2718
https://doi.org/10.1093/cid/ciz977 pmid: 31605485
9 DL Stevens, AL Bisno, HF Chambers, EP Dellinger, EJ Goldstein, SL Gorbach, JV Hirschmann, SL Kaplan, JG Montoya, JC; Infectious Diseases Society of America Wade. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59(2): e10–e52
https://doi.org/10.1093/cid/ciu296 pmid: 24973422
10 E Morgan, S Hohmann, JP Ridgway, RS Daum, MZ David. Decreasing incidence of skin and soft-tissue infections in 86 US Emergency Departments, 2009–2014. Clin Infect Dis 2019; 68(3): 453–459
https://doi.org/10.1093/cid/ciy509 pmid: 29912305
11 CN Kotton. Skin and soft tissue infections in the transplant population. Curr Infect Dis Rep 2008; 10(5): 387–393
https://doi.org/10.1007/s11908-008-0063-2 pmid: 18687203
12 AL Hersh, HF Chambers, JH Maselli, R Gonzales. National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections. Arch Intern Med 2008; 168(14): 1585–1591
https://doi.org/10.1001/archinte.168.14.1585 pmid: 18663172
13 LG Miller, DF Eisenberg, H Liu, CL Chang, Y Wang, R Luthra, A Wallace, C Fang, J Singer, JA Suaya. Incidence of skin and soft tissue infections in ambulatory and inpatient settings, 2005–2010. BMC infect Dis 2015; 15: 362
https://doi.org/10.1186/s12879-015-1071-0 pmid: 26293161
14 Y Wang, DH Liu, KY Liu, LP Xu, XH Zhang, W Han, H Chen, YH Chen, FR Wang, JZ Wang, YQ Sun, XJ Huang. Long-term follow-up of haploidentical hematopoietic stem cell transplantation without in vitro T cell depletion for the treatment of leukemia: nine years of experience at a single center. Cancer 2013; 119(5): 978–985
https://doi.org/10.1002/cncr.27761 pmid: 23097265
15 DH Liu, LP Xu, XH Zhang, Y Wang, CH Yan, JZ Wang, FR Wang, YQ Sun, Y Ji, YY Zhang, KY Liu, XJ Huang. Substitution of cyclophosphamide in the modified BuCy regimen with fludarabine is associated with increased incidence of severe pneumonia: a prospective, randomized study. Int J Hematol 2013; 98(6): 708–715
https://doi.org/10.1007/s12185-013-1460-3 pmid: 24242024
16 YR Lai, YH Chen, DM Hu, M Jiang, QF Liu, L Liu, J Hou, P Schwarzenberger, QC Li, ZM Zhang, KY Liu, XJ Huang. Multicenter phase II study of a combination of cyclosporine A, methotrexate and mycophenolate mofetil for GVHD prophylaxis: results of the Chinese Bone Marrow Transplant Cooperative Group (CBMTCG). J Hematol Oncol 2014; 7: 59
https://doi.org/10.1186/s13045-014-0059-3 pmid: 25139202
17 XJ Huang, DH Liu, KY Liu, LP Xu, H Chen, W Han, YH Chen, XH Zhang, DP Lu. Treatment of acute leukemia with unmanipulated HLA-mismatched/haploidentical blood and bone marrow transplantation. Biol Blood Marrow Transplant 2009; 15(2): 257–265
https://doi.org/10.1016/j.bbmt.2008.11.025 pmid: 19167686
18 XD Mo, X Yan, W Hu, XH Zhang, LP Xu, Y Wang, XD Xu, LN Wang, XX He, CH Yan, H Chen, YH Chen, KY Liu, XJ Huang. Perianal infections in the phase before engraftment after allogeneic hematopoietic stem cell transplantations: a study of the incidence, risk factors, and clinical outcomes. Acta Haematol 2018; 139(1): 19–27
https://doi.org/10.1159/000481723 pmid: 29320771
19 R Bystritsky, H Chambers. Cellulitis and soft tissue infections. Ann Intern Med 2018; 168(3): ITC17–ITC32
https://doi.org/10.7326/AITC201802060 pmid: 29404597
20 ML Sorror, MB Maris, R Storb, F Baron, BM Sandmaier, DG Maloney, B Storer. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 2005; 106(8): 2912–2919
https://doi.org/10.1182/blood-2005-05-2004 pmid: 15994282
21 CH Yan, LP Xu, FR Wang, H Chen, W Han, Y Wang, JZ Wang, KY Liu, XJ Huang. Causes of mortality after haploidentical hematopoietic stem cell transplantation and the comparison with HLA-identical sibling hematopoietic stem cell transplantation. Bone Marrow Transplant 2016; 51(3): 391–397
https://doi.org/10.1038/bmt.2015.306 pmid: 26691421
22 J Styczyński, G Tridello, L Koster, S Iacobelli, Biezen A van, der Werf S van, M Mikulska, L Gil, C Cordonnier, P Ljungman, D Averbuch, S Cesaro, la Camara R de, H Baldomero, P Bader, G Basak, C Bonini, R Duarte, C Dufour, J Kuball, A Lankester, S Montoto, A Nagler, JA Snowden, N Kröger, M Mohty, A; Infectious Diseases Working Party EBMT Gratwohl. Death after hematopoietic stem cell transplantation: changes over calendar year time, infections and associated factors. Bone Marrow Transplant 2020; 55(1): 126–136
https://doi.org/10.1038/s41409-019-0624-z pmid: 31455899
23 D Przepiorka, D Weisdorf, P Martin, HG Klingemann, P Beatty, J Hows, ED Thomas. 1994 Consensus Conference on Acute GVHD Grading. Bone Marrow Transplant 1995; 15(6): 825–828
pmid: 7581076
24 MH Jagasia, HT Greinix, M Arora, KM Williams, D Wolff, EW Cowen, J Palmer, D Weisdorf, NS Treister, GS Cheng, H Kerr, P Stratton, RF Duarte, GB McDonald, Y Inamoto, A Vigorito, S Arai, MB Datiles, D Jacobsohn, T Heller, CL Kitko, SA Mitchell, PJ Martin, H Shulman, RS Wu, CS Cutler, GB Vogelsang, SJ Lee, SZ Pavletic, ME Flowers. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group report. Biol Blood Marrow Transplant 2015; 21(3): 389–401.e381
https://doi.org/10.1016/j.bbmt.2014.12.001 pmid: 25529383
25 CH Yan, Y Wang, XD Mo, YQ Sun, FR Wang, HX Fu, Y Chen, TT Han, J Kong, YF Cheng, XH Zhang, LP Xu, KY Liu, XJ Huang. Incidence, risk factors, microbiology and outcomes of pre-engraftment bloodstream infection after haploidentical hematopoietic stem cell transplantation and comparison with HLA-identical sibling transplantation. Clin Infect Dis 2018; 67(suppl_2): S162–S173
https://doi.org/10.1093/cid/ciy658 pmid: 30423054
26 C Yuan, AM Boyd, J Nelson, RD Patel, JC Varela, SC Goldstein, S Ahmad, X Zhu, S Mori. Eltrombopag for treating thrombocytopenia after allogeneic stem cell transplantation. Biol Blood Marrow Transplant 2019; 25(7): 1320–1324
https://doi.org/10.1016/j.bbmt.2019.01.027 pmid: 30710685
27 MS Dryden. Complicated skin and soft tissue infection. J Antimicrob Chemother 2010; 65(Suppl 3): iii35–44 doi: 10.1093/jac/dkq302
pmid: 20876627
28 AC Kalil, ML Metersky, M Klompas, J Muscedere, DA Sweeney, LB Palmer, LM Napolitano, NP O’Grady, JG Bartlett, J Carratalà, Solh AA El, S Ewig, PD Fey, TM Jr File, MI Restrepo, JA Roberts, GW Waterer, P Cruse, SL Knight, JL Brozek. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis 2016; 63(5): e61–e111
https://doi.org/10.1093/cid/ciw353 pmid: 27418577
29 OT Ranzani, T Senussi, F Idone, A Ceccato, G Li Bassi, M Ferrer, A Torres. Invasive and non-invasive diagnostic approaches for microbiological diagnosis of hospital-acquired pneumonia. Crit Care 2019; 23(1): 51
https://doi.org/10.1186/s13054-019-2348-2 pmid: 30777114
30 RN Pugh, IM Murray-Lyon, JL Dawson, MC Pietroni, R Williams. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973; 60(8): 646–649
https://doi.org/10.1002/bjs.1800600817 pmid: 4541913
31 A Khwaja. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract 2012; 120(4): c179–c184
pmid: 22890468
32 YJ Chang, XY Zhao, LP Xu, XH Zhang, Y Wang, W Han, H Chen, FR Wang, XD Mo, YY Zhang, MR Huo, XS Zhao, K Y, KY Liu, XJ Huang. Donor-specific anti-human leukocyte antigen antibodies were associated with primary graft failure after unmanipulated haploidentical blood and marrow transplantation: a prospective study with randomly assigned training and validation sets. J Hematol Oncol 2015; 8: 84
https://doi.org/10.1186/s13045-015-0182-9 pmid: 26156584
33 Y Kong, YJ Chang, YZ Wang, YH Chen, W Han, Y Wang, YQ Sun, CH Yan, FR Wang, YR Liu, LP Xu, DH Liu, XJ Huang. Association of an impaired bone marrow microenvironment with secondary poor graft function after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2013; 19(10): 1465–1473
https://doi.org/10.1016/j.bbmt.2013.07.014 pmid: 23879970
34 E Klyuchnikov, J El-Cheikh, A Sputtek, M Lioznov, B Calmels, S Furst, C Chabannon, R Crocchiolo, C Lemarié, C Faucher, U Bacher, H Alchalby, T Stübig, C Wolschke, F Ayuk, ML Reckhaus, D Blaise, N Kröger. CD34(+)-selected stem cell boost without further conditioning for poor graft function after allogeneic stem cell transplantation in patients with hematological malignancies. Biol Blood Marrow Transplant 2014; 20(3): 382–386
https://doi.org/10.1016/j.bbmt.2013.11.034 pmid: 24321747
35 FF Tang, XS Zhao, LP Xu, XH Zhang, YH Chen, XD Mo, YQ Sun, KY Liu, XJ Huang. Risk factors for herpes simplex virus-1/2 viremia and clinical outcomes following unmanipulated haploidentical haematopoietic stem cell transplantation. J Clin Virol 2017; 95: 20–25
https://doi.org/10.1016/j.jcv.2017.07.018 pmid: 28837858
36 S Zanwar, P Jain, A Gokarn, SK Devadas, S Punatar, S Khurana, A Bonda, R Pruthy, V Bhat, S Qureshi, N Khattry. Antibiotic lock therapy for salvage of tunneled central venous catheters with catheter colonization and catheter-related bloodstream infection. Transpl Infect Dis 2019; 21(1): e13017
https://doi.org/10.1111/tid.13017 pmid: 30369006
37 SP Yeh, CF Chiu, WJ Lo, CL Lin, CT Hsueh, YM Liao, YC Shen. Low infectious morbidity in patients with heavily pretreated hematological malignancies receiving autologous peripheral blood stem cell transplantation without antimicrobial prophylaxis. Ann Hematol 2003; 82(1): 24–29
https://doi.org/10.1007/s00277-002-0567-z pmid: 12574960
38 L Leibovici, M Paul, M Cullen, G Bucaneve, A Gafter-Gvili, A Fraser, WV Kern. Antibiotic prophylaxis in neutropenic patients: new evidence, practical decisions. Cancer 2006; 107(8): 1743–1751
https://doi.org/10.1002/cncr.22205 pmid: 16977651
39 S Kimura, Y Akahoshi, H Nakano, T Ugai, H Wada, R Yamasaki, Y Ishihara, K Kawamura, K Sakamoto, M Ashizawa, M Sato, K Terasako-Saito, H Nakasone, M Kikuchi, R Yamazaki, S Kako, J Kanda, A Tanihara, J Nishida, Y Kanda. Antibiotic prophylaxis in hematopoietic stem cell transplantation. A meta-analysis of randomized controlled trials. J Infect 2014; 69(1): 13–25
https://doi.org/10.1016/j.jinf.2014.02.013 pmid: 24583063
40 AJ Ullmann, M Schmidt-Hieber, H Bertz, WJ Heinz, M Kiehl, W Krüger, S Mousset, S Neuburger, S Neumann, O Penack, G Silling, JJ Vehreschild, H Einsele, G; Infectious Diseases Working Party of the German Society for Hematology Maschmeyer, Oncology (AGIHO/DGHO) Medical, DAG-KBT (German Working Group for Blood the, Transplantation) Marrow. Infectious diseases in allogeneic haematopoietic stem cell transplantation: prevention and prophylaxis strategy guidelines 2016. Ann Hematol 2016; 95(9): 1435–1455
https://doi.org/10.1007/s00277-016-2711-1 pmid: 27339055
41 C Cordonnier, M Rovira, J Maertens, E Olavarria, C Faucher, K Bilger, A Pigneux, OA Cornely, AJ Ullmann, RM Bofarull, la Cámara R de, M Weisser, E Liakopoulou, M Abecasis, CP Heussel, M Pineau, P Ljungman, H; Voriconazole for Secondary Prophylaxis of Invasive Fungal Infections in Patients With Allogeneic Stem Cell Transplants (VOSIFI) study group; Infectious Diseases Working Party Einsele, Group for Blood European, Transplantation Marrow. Voriconazole for secondary prophylaxis of invasive fungal infections in allogeneic stem cell transplant recipients: results of the VOSIFI study. Haematologica 2010; 95(10): 1762–1768
https://doi.org/10.3324/haematol.2009.020073 pmid: 20634495
42 E Gluckman, J Lotsberg, A Devergie, XM Zhao, R Melo, M Gomez-Morales, T Nebout, MC Mazeron, Y Perol. Prophylaxis of herpes infections after bone-marrow transplantation by oral acyclovir. Lancet 1983; 322(8352): 706–708
https://doi.org/10.1016/S0140-6736(83)92248-1 pmid: 6136841
43 M Boeckh, HW Kim, ME Flowers, JD Meyers, RA Bowden. Long-term acyclovir for prevention of varicella zoster virus disease after allogeneic hematopoietic cell transplantation—a randomized double-blind placebo-controlled study. Blood 2006; 107(5): 1800–1805
https://doi.org/10.1182/blood-2005-09-3624 pmid: 16282339
44 V Erard, A Wald, L Corey, WM Leisenring, M Boeckh. Use of long-term suppressive acyclovir after hematopoietic stem-cell transplantation: impact on herpes simplex virus (HSV) disease and drug-resistant HSV disease. J Infect Dis 2007; 196(2): 266–270
https://doi.org/10.1086/518938 pmid: 17570114
45 KA Marr, F Crippa, W Leisenring, M Hoyle, M Boeckh, SA Balajee, WG Nichols, B Musher, L Corey. Itraconazole versus fluconazole for prevention of fungal infections in patients receiving allogeneic stem cell transplants. Blood 2004; 103(4): 1527–1533
https://doi.org/10.1182/blood-2003-08-2644 pmid: 14525770
46 A Glasmacher, E Molitor, C Hahn, K Bomba, S Ewig, C Leutner, E Wardelmann, IG Schmidt-Wolf, J Mezger, G Marklein, T Sauerbruch. Antifungal prophylaxis with itraconazole in neutropenic patients with acute leukaemia. Leukemia 1998; 12(9): 1338–1343
https://doi.org/10.1038/sj.leu.2401137 pmid: 9737680
47 A Glasmacher, C Hahn, C Leutner, E Molitor, E Wardelmann, C Losem, T Sauerbruch, G Marklein, IG Schmidt-Wolf. Breakthrough invasive fungal infections in neutropenic patients after prophylaxis with itraconazole. Mycoses 1999; 42(7-8): 443–451
https://doi.org/10.1046/j.1439-0507.1999.00505.x pmid: 10546485
48 A Grigorian, S Schubl, C Jr Barrios, V Joe, M Dolich, M Lekawa, J Nahmias. Association of heparin-induced thrombocytopenia with bacterial infection in trauma patients. JAMA Surg 2018; 153(10): 964–965
https://doi.org/10.1001/jamasurg.2018.1652 pmid: 29955756
49 A Gafter-Gvili, N Mansur, A Bivas, N Zemer-Wassercug, J Bishara, L Leibovici, M Paul. Thrombocytopenia in Staphylococcus aureus bacteremia: risk factors and prognostic importance. Mayo Clin Proc 2011; 86(5): 389–396
https://doi.org/10.4065/mcp.2010.0705 pmid: 21531882
50 KD Mason, MR Carpinelli, JI Fletcher, JE Collinge, AA Hilton, S Ellis, PN Kelly, PG Ekert, D Metcalf, AW Roberts, DC Huang, BT Kile. Programmed anuclear cell death delimits platelet life span. Cell 2007; 128(6): 1173–1186
https://doi.org/10.1016/j.cell.2007.01.037 pmid: 17382885
51 Y Xie, R Tian, H Xie, W Jin, J Du, P Huang, Z Zhou, R Wang. The clinical significance of thrombocytopenia complicating sepsis: a meta-analysis. J Infect 2019; 78(4): 323–337
https://doi.org/10.1016/j.jinf.2018.12.002 pmid: 30629960
52 AY Young, MM Leiva Juarez, SE Evans. Fungal pneumonia in patients with hematologic malignancy and hematopoietic stem cell transplantation. Clin Chest Med 2017; 38(3): 479–491
https://doi.org/10.1016/j.ccm.2017.04.009 pmid: 28797490
53 M Aguilar-Guisado, M Jiménez-Jambrina, I Espigado, M Rovira, R Martino, A Oriol, N Borrell, I Ruiz, P Martín-Dávila, la Cámara R de, M Salavert, la Torre J de, JM; Spanish Network for Research in Infectious Diseases Cisneros. Pneumonia in allogeneic stem cell transplantation recipients: a multicenter prospective study. Clin Transplant 2011; 25(6): E629–E638
https://doi.org/10.1111/j.1399-0012.2011.01495.x pmid: 22150886
54 SR Wilkes, E Burden-Teh, F Robertson, D Grindlay, NM Selby. Skin and soft tissue infections and acute kidney injury: a systematic review. Br J Dermatol 2016; 175(1): 182–184
https://doi.org/10.1111/bjd.14368 pmid: 26707086
55 Y Liu, L Xu, X Zhang, Y Wang, K Liu, H Chen, Y Chen, W Han, C Yan, X Huang. Acute kidney injury following haplo stem cell transplantation: incidence, risk factors and outcome. Bone Marrow Transplant 2018; 53(4): 483–486
https://doi.org/10.1038/s41409-017-0030-3 pmid: 29330400
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