Risk factors for recurrence of invasive fungal infection during secondary antifungal prophylaxis in allogeneic hematopoietic stem cell transplant recipients

• Published in: Transplant infectious disease 2013-06, Vol.15 (3), p.243-250
• Main Authors: Liu, F., Wu, T., Wang, J.B., Cao, X.Y., Yin, Y.M., Zhao, Y.L., Lu, D.P.
• Format: Article
• Language: English
• Subjects: allogeneic hematopoietic stem cell transplantation; Antibiotic Prophylaxis; Antifungal agents; Antifungal Agents - therapeutic use; Female; Graft vs Host Disease - complications; Graft vs Host Disease - drug therapy; Granulocyte Colony-Stimulating Factor - therapeutic use; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; invasive fungal infections; Male; Mycoses - drug therapy; Mycoses - prevention & control; Recurrence; Retrospective Studies; Risk Factors; secondary antifungal prophylaxis; Transplantation, Homologous - adverse effects
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/tid.12068

Background Invasive fungal infections (IFIs) are a major cause of mortality among allogeneic hematopoietic stem cell transplantation (allo‐HSCT) patients. Thanks to the widespread use of secondary antifungal prophylaxis (SAP), a history of IFI is not an absolute contraindication to allo‐HSCT. However, IFI recurrence remains a risk factor for transplant‐related mortality. Methods To evaluate the risk factors for IFI recurrence in allo‐HSCT patients receiving SAP, we performed a retrospective analysis of 90 individuals treated at our hospital. SAP antifungal agents included fluconazole (n = 28), voriconazole (n = 25), itraconazole (n = 23), caspofungin (n = 7), and micafungin (n = 7). Results By day +100, recurrent IFI had occurred in 23 (25.5%) patients. Our multivariate analysis identified 4 factors significantly associated with a risk of IFI recurrence within 100 days of allo‐HSCT: duration of neutropenia >18 days, presence of severe acute graft‐versus‐host disease (aGVHD),