Positive stool culture could predict the clinical outcomes of haploidentical hematopoietic stem cell transplantation

Abstract

We aimed to identify the effect of positive stool cultures (PSCs) on the clinical outcomes of patients undergoing haploidentical hematopoietic stem cell transplantation (haplo-HSCT) (n = 332). PSCs were observed in 61 patients (PSC group, 18.4%). Enterobacteriaceae in stool specimens was associated with a higher risk of bloodstream infection, and Candida in stool specimens was related to a higher risk of platelet engraftment failure. The cumulative incidence of infection-related mortality 1 year after haplo-HSCT in the PSC group was higher than that of the patients who showed persistently negative stool cultures (NSC group; 19.2% vs. 8.9%, P = 0.017). The probabilities of overall survival (71.4% vs. 83.8%, P = 0.031) and disease-free survival (69.6% vs. 81.0%, P = 0.048) 1 year after haplo-HSCT for the PSC group were significantly lower than those for the NSC group, particularly for patients who had Candida in their stool specimens. In multivariate analysis, Candida in stool specimens significantly increased the risk of mortality and was associated with poorer survival. Our results showed that PSC influenced the clinical outcomes after haplo-HSCT, particularly those who had Candida in their stool specimens.

Keywords

haploidentical / hematopoietic stem cell transplantation / stool culture / Candida

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Acknowledgements

This work was supported by the National Natural Science Foundation of China (No. 81802070), China Postdoctoral Science Foundation (No. 2018M631280), the Capital’s Funds for Health Improvement and Research (No. 2018-4-4089), the Key Program of the National Natural Science Foundation of China (No. 81530046), the Foundation for Innovative Research Groups of the National Natural Science Foundation of China (No. 81621001), the Science and Technology Project of the Guangdong Province of China (No. 2016B030230003), and the Project of Health Collaborative Innovation of Guangzhou City (No. 201704020214).

Compliance with ethics guidelines

Lijuan Hu, Qi Wang, Xiaohui Zhang, Lanping Xu, Yu Wang, Chenhua Yan, Huan Chen, Yuhong Chen, Kaiyan Liu, Hui Wang, Xiaojun Huang, and Xiaodong Mo declare that they have no potential financial conflict of interests related to this manuscript. Informed consent was obtained from all patients or their guardians, and the study was conducted in accordance with the Declaration of Helsinki. The study protocol was approved by the Ethics Committee of Peking University People’s Hospital.

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