Risk Factors for Invasive Fungal Disease after Allogeneic Hematopoietic Stem Cell Transplantation: A Single Center Experience

• Published in: Biology of blood and marrow transplantation 2013-08, Vol.19 (8), p.1190-1196
• Main Authors: Omer, Aazim K, Ziakas, Panayiotis D, Anagnostou, Theodora, Coughlin, Erin, Kourkoumpetis, Themistoklis, McAfee, Steven L, Dey, Bimalangshu R, Attar, Eyal, Chen, Yi-Bin, Spitzer, Thomas R, Mylonakis, Eleftherios, Ballen, Karen K
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Allogeneic hematopoietic stem cell transplantation; CD34+ cell; Female; Hematology, Oncology and Palliative Medicine; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Invasive fungal disease; Male; Middle Aged; Mycoses - blood; Mycoses - etiology; Mycoses - prevention & control; Retrospective Studies; Risk Factors; Survival Analysis; Young Adult
• ISSN: 1083-8791; 1523-6536
• DOI: 10.1016/j.bbmt.2013.05.018

Abstract Invasive fungal disease (IFD) is a major cause of morbidity and mortality after hematopoietic stem cell transplantation (HCT). We performed a retrospective review of 271 adults with a hematologic malignancy undergoing allogeneic HCT to determine the incidence of and risk factors for IFD and to examine the impact of IFD on nonrelapse mortality and overall survival. We defined IFD using standard criteria and selected proven and probable cases for analysis. Diagnoses in the study group included acute leukemia (42%), non-Hodgkin lymphoma (24%), myelodysplastic syndrome (15%), chronic lymphocytic leukemia (5%), and other hematologic disorders (14%). Conditioning included reduced-intensity (64%) and myeloablative (36%) regimens. Donor sources were HLA-matched sibling (60%), matched unrelated (20%), haploidentical (12%), and cord blood (8%). A total of 51 episodes of IFD were observed in 42 subjects (15%). Aspergillus spp (47%) was the most frequent causative organism, followed by Candida spp (43%). The majority of IFD cases (67%) were reported after day +100 post-HCT. In multivariate analysis, haploidentical donor transplantation (hazard ratio [HR], 3.82; 95% confidence interval [CI], 1.49-9.77; P  = .005) and grade II-IV acute graft-versus-host disease (HR, 2.55; 95% CI, 1.07-6.10; P  = .03) were risk factors for the development of IFD. Conversely, higher infused CD34+ cell dose was associated with a lower risk of IFD (HR, 0.80; 95% CI, 0.68-0.94; P  = .006, per 1 × 106 cells/kg increase in CD34+ cell infusion). IFD-related mortality was 33.3%. Nonrelapse mortality was significantly higher in patients who developed IFD compared with those without IFD ( P