Antibiotics after allogeneic HSCT: beware of Graft vs Host disease

A large study investigated the temporal relationship between antibiotics and rejection in GvHD after allogeneic haematopoietic stem cell transplantation.

Effects of antibiotics after allogeneic haematopoietic cell transplantation

Antibiotics can usually not be avoided

After allogeneic haematopoietic stem cell transplantation, quite a few patients need antibiotics; in many cases even more than one. Concerns about infection or the treatment of an existing infectious disease make it difficult to avoid antibiotics completely. However, the drugs have been associated with increased incidences of GvHD for some time.

Is there a temporal relationship between antibiotics and GvHD?

A recent study addressed this issue and investigated whether there is a temporal relationship between antibiotic administration and GvHD. To this end, they analysed the data of over 2,000 people who had received an allogeneic stem cell transplant and antibiotics. The observation period was six months after transplantation.

Are there increased rates of GvHD with antibiotics?

Especially in the first two weeks after transplantation, there is an increased incidence of GvHD when antibiotics are also administered. This applies to several antibiotic groups. However, two stand out: carbapenems and penicillins with ß-lactamase inhibitors very frequently lead to graft-vs-host disease. With carbapenems, the first two weeks after stem cell transplantation are particularly susceptible to GvHD, while with penicillins the risk is greatest in the first week post-transplantation. 

Take away for medical practice

In many cases, the administration of antibiotics after a stem cell transplant cannot be avoided. Nevertheless, the data show that certain antibiotics may be associated with a higher risk of Graft vs Host disease if they are given early after transplantation. If necessary, this should be taken into account when planning treatment in order to reduce complications.

  1. Rashidi A, Gao F, Fredricks DN, Pergam SA, Mielcarek M, Milano F, Sandmaier BM, Lee SJ. Analysis of Antibiotic Exposure and Development of Acute Graft-vs-Host Disease Following Allogeneic Hematopoietic Cell Transplantation. JAMA Netw Open. 2023 Jun