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

Br J Haematol. 2002 Feb;116(2):475-82. doi: 10.1046/j.1365-2141.2002.03259.x.

Abstract

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.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aspergillosis / complications*
  • Aspergillosis / mortality
  • Candidiasis / complications*
  • Candidiasis / mortality
  • Female
  • Glucocorticoids / adverse effects
  • Glucocorticoids / therapeutic use
  • Graft vs Host Disease / complications
  • Hematopoietic Stem Cell Transplantation* / mortality
  • Humans
  • Incidence
  • Leukemia / microbiology
  • Leukemia / mortality
  • Leukemia / therapy*
  • Lymphoma / microbiology
  • Lymphoma / mortality
  • Lymphoma / therapy*
  • Male
  • Middle Aged
  • Morbidity
  • Multivariate Analysis
  • Myelodysplastic Syndromes / microbiology
  • Myelodysplastic Syndromes / mortality
  • Myelodysplastic Syndromes / therapy*
  • Postoperative Complications
  • Risk Factors
  • Transplantation, Homologous

Substances

  • Glucocorticoids