Epidemiology and Outcome of Invasive Fungal Infection in Adult Hematopoietic Stem Cell Transplant Recipients: Analysis of Multicenter Prospective Antifungal Therapy (PATH) Alliance Registry

Neofytos, Dionysios; Horn, David L.; Anaissie, Elias; Steinbach, William J.; Olyaei, Ali J.; Fishman, Jay A.; Pfaller, Michael A.; Chang, Chih‐Hao; Webster, Karen M.; Marr, Kieren A.

doi:10.1086/595846

Cited by 703 publications

(597 citation statements)

References 18 publications

(17 reference statements)

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“…[3][4][5]11 Concerning the type and timing of IFD, we found that, as in previous studies, Aspergillus spp. was the most frequent isolate and the lungs were the most common site, 18 and that the CI of IFD increased during the first year with a gradual decline of episodes until 5 years after SCT.…”

Section: Discussionmentioning

confidence: 92%

Incidence and risk factors of post-engraftment invasive fungal disease in adult allogeneic hematopoietic stem cell transplant recipients receiving oral azoles prophylaxis

Montesinos

Rodríguez‐Veiga

Boluda

et al. 2015

Bone Marrow Transplant

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Studies that analyze the epidemiology and risk factors for invasive fungal disease (IFD) after engraftment in alloSCT are few in number. This single-center retrospective study included 404 alloSCT adult recipients surviving 440 days who engrafted and were discharged without prior IFD. All patients who received ⩾ 20 mg/day of prednisone were assigned to primary oral prophylaxis (itraconazole or low-dose voriconazole). The primary end point was the cumulative incidence (CI) of probable/proven IFD using the European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC/MSG) criteria. The independent prognostic factors after multivariate analyses were used to construct a post-engraftment IFD risk score. The 1-year CI of IFD was 11%. The non-relapse mortality was 40% in those developing IFD and 16% in those who did not. The intent-to-treat analysis showed that 17% of patients abandoned the assigned prophylaxis. Age 440 years, ⩾ 1 previous SCT, pre-engraftment neutropenia 415 days, extensive chronic GVHD and CMV reactivation were independent risk factors. The post-engraftment IFD score stratified patients into low risk (0-1 factor, CI 0.7%), intermediate risk (2 factors, CI 9.9%) and high risk (3-5 factors, CI 24.7%) (P o 0.0001). The antifungal prophylaxis strategy failed to prevent post-engraftment IFD in 11% of alloSCT. Our risk score could be useful to implement risk-adapted strategies using antifungal prophylaxis after engraftment.

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Section: Discussionmentioning

confidence: 92%

Incidence and risk factors of post-engraftment invasive fungal disease in adult allogeneic hematopoietic stem cell transplant recipients receiving oral azoles prophylaxis

Montesinos

Rodríguez‐Veiga

Boluda

et al. 2015

Bone Marrow Transplant

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“…attack rate) has been reported extensively in patients with various hematologic diseases. 3,4,7,14,[25][26][27] While IA increased in the 1980s-1990s in the general population, 2 no reduction in IA incidence has been observed in hematology patients. 3,28 In our study, the decrease in IA incidence could be explained by medical prophylaxis with posaconazole which has been used systematically in all patients with AML in induction chemotherapy since 2007 in our setting.…”

Section: Discussionmentioning

confidence: 99%

Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from 2004 to 2009

Nicolle¹,

Bénet²,

Thiébaut³

et al. 2011

Haematologica

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BackgroundThe study objectives were: 1) to report on invasive aspergillosis patients in a hematology department; and 2) to estimate its incidence according to the hematologic diagnosis. Design and MethodsA prospective survey of invasive aspergillosis cases was undertaken between January 2004 and December 2009 in the hematology department of a university hospital. Meetings with clinicians, mycologists and infection control practitioners were organized monthly to confirm suspected aspergillosis cases. Demographic characteristics, clinical and complementary examination results were recorded prospectively. Information on hospitalization was extracted from administrative databases. Invasive aspergillosis diagnosis followed the European Organization for Research and Treatment of Cancer criteria, and proven and probable IA cases were retained. A descriptive analysis was conducted with temporal trends of invasive aspergillosis incidence assessed by adjusted Poisson regression. ResultsOverall, 4,073 hospitalized patients (78,360 patient-days) were included in the study. In total, 127 (3.1%) patients presented invasive aspergillosis. The overall incidence was 1.6 per 1,000 patient-days (95% confidence interval: 1.4, 1.9) with a decrease of 16% per year (-1%, -28%). The incidence was 1.9 per 1,000 patient-days (1.5, 2.3) in acute myeloid leukemia patients with a decrease of 20% per year (-6%, -36%). Serum Aspergillus antigen was detected in 89 (71%) patients; 29 (23%) had positive cultures, and 118 (93%), abnormal lung CT scans. One-month mortality was 13%; 3-month mortality was 42%. Mortality tended to decrease between 2004 and 2009. ConclusionsInvasive aspergillosis incidence and mortality declined between 2004 and 2009. Knowledge of invasive aspergillosis characteristics and its clinical course should help to improve the management of these patients with severe disease.Key words: invasive aspergillosis, surveillance, hematologic disease, incidence, hospital. 2004 . Haematologica 2011 96(11):1685-1691. doi:10.3324/haematol.2011 Citation: Nicolle M-C, Bénet T, Thiebaut A, Bienvenu A-L, Voirin N, Duclos A, Sobh M, Cannas G, Thomas X, Nicolini F-E, De Monbrison F, Piens M-A, Picot S, Michallet M, and Vanhems P. Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from

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“…In the 1990s, the frequency of systemic candidiasis sharply declined while the incidence of invasive aspergillosis (IA) rose from 6 to 11% during allogeneic HSCT [1]. In recent years, large surveillance networks reported IA as the most common invasive fungal infection (IFI) during HSCT; IA accounted for 59% of IFI followed by invasive candidiasis (25%), zygomycosis (7%) and IFI due to other molds (7%) [2,3]. Since 2002, the availability and increasing use of voriconazole, an antifungal triazole, may have contributed to a reduced incidence of IA, while zygomycosis and other mold infections are encountered more commonly.…”

mentioning

confidence: 99%

Challenges in the management of invasive aspergillosis in hematopoietic stem cell transplantation

Chandrasekar

Ramesh

2009

Expert Review of Anti-infective Therapy

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Epidemiology and Outcome of Invasive Fungal Infection in Adult Hematopoietic Stem Cell Transplant Recipients: Analysis of Multicenter Prospective Antifungal Therapy (PATH) Alliance Registry

Cited by 703 publications

References 18 publications

Incidence and risk factors of post-engraftment invasive fungal disease in adult allogeneic hematopoietic stem cell transplant recipients receiving oral azoles prophylaxis

Incidence and risk factors of post-engraftment invasive fungal disease in adult allogeneic hematopoietic stem cell transplant recipients receiving oral azoles prophylaxis

Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from 2004 to 2009

Challenges in the management of invasive aspergillosis in hematopoietic stem cell transplantation

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