Invasive fungal infections after allogeneic peripheral blood stem cell transplantation: incidence and risk factors in 395 patients

• Published in: British journal of haematology Vol. 116; no. 2; pp. 475 - 482
• Main Authors: Martino, Rodrigo, Subirá, Maricel, Rovira, Montserrat, Solano, Carlos, Vázquez, Lourdes, Sanz, Guillermo F., Urbano‐Ispizua, Alvaro, Brunet, Salut, De la Cámara, Rafael
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science, Ltd 01.02.2002; Blackwell; Blackwell Publishing Ltd
• Subjects: Adolescent; Adult; Aged; allogeneic; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aspergillosis - complications; Aspergillosis - mortality; Biological and medical sciences; Bone marrow, stem cells transplantation. Graft versus host reaction; Candidiasis - complications; Candidiasis - mortality; Female; fungal infections; Glucocorticoids - adverse effects; Glucocorticoids - therapeutic use; Graft vs Host Disease - complications; Hematology; Hematopoietic Stem Cell Transplantation - mortality; Human mycoses; Humans; Incidence; Infectious diseases; Leukemia - microbiology; Leukemia - mortality; Leukemia - therapy; Lymphoma - microbiology; Lymphoma - mortality; Lymphoma - therapy; Male; Medical sciences; Middle Aged; Morbidity; Multivariate Analysis; Mycoses; Mycotic sepsis; Myelodysplastic Syndromes - microbiology; Myelodysplastic Syndromes - mortality; Myelodysplastic Syndromes - therapy; peripheral blood stem cell transplantation; Postoperative Complications; Risk Factors; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation, Homologous; Human; Opportunistic infection; Mycosis; Stem cell; Hematopoietic cell; Homograft; Epidemiology; Recommendation; Blood; Incidence; Infection; Prevention; Treatment; Risk factor; Graft; Complication
• ISSN: 0007-1048; 1365-2141
• DOI: 10.1046/j.1365-2141.2002.03259.x

We have analysed the incidence and risk factors for the occurrence of invasive fungal infections (IFI) among 395 recipients of an allogeneic peripheral blood stem cell transplantation (PBSCT) from a human leucocyte antigen (HLA)‐identical sibling. IFI (n = 50) occurred in 46 patients, giving an overall probability of 14%. There were 12 cases of invasive candidiasis (3%), with only one death. Non‐Candida IFI occurred in 37 patients (12% probability), mostly invasive aspergillosis (n = 32). In multivariate analysis the only two significant variables associated with a higher risk of developing a non‐Candida IFI were the development of moderate‐to‐severe graft‐versus‐host disease (GvHD, P < 0·0001; OR 4·6) and having received steroid prophylaxis for GvHD (P = 0·04; OR 2·1). In multivariate analysis the variables associated with a lower overall survival after PBSCT were development of a non‐Candida IFI (P < 0·0001; OR 5·6), non‐early disease phase (P = 0·0001; OR 1·9), steroid prophylaxis (P = 0·02; OR 1·4), moderate‐to‐severe GvHD (P = 0·01; OR 1·6) and cytomegalovirus infection post transplant (P = 0·001; OR 1·8). Our results show that non‐Candida IFI (in particular aspergillosis) was an important cause of infectious morbidity and mortality after an HLA‐identical sibling PBSCT, while invasive candidiasis was rare. Use of steroid prophylaxis and, in particular, the development of moderate‐to‐severe GvHD post transplant were risk factors for non‐Candida IFI. Prophylactic strategies for these infections should thus take into account these risk factors.