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

Abstract

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.

Invasive fungal disease in patients undergoing umbilical cord blood transplantation after myeloablative conditioning regimen

“…12,14 In this regard, we previously reported that low-dose voriconazole was clearly insufficient to prevent IFD compared to full dose in allo-HSCT recipients. 7 As a result of this high incidence of IFD, since January 2017, we changed our antimold prophylactic strategy to posaconazole 300 mg daily.…”

Reassessment of clinical implication of pretransplant surgical procedures for pulmonary invasive fungal lesions

“…GVHD occurring before day 100 after allo‐SCT was classified as acute GVHD, whereas that occurring after day 100 after allo‐SCT was classified as chronic GVHD . Both acute and chronic GVHD were evaluated according to the standard classifications published elsewhere . All patients were assessed for the following recently identified risk factors for pulmonary IFD after allo‐SCT; age (40 years), previous episode of allo‐SCT, persistent neutropenia, extensive chronic GVHD, and reactivation of cytomegalovirus.…”

“…Both acute and chronic GVHD were evaluated according to the standard classifications published elsewhere . All patients were assessed for the following recently identified risk factors for pulmonary IFD after allo‐SCT; age (40 years), previous episode of allo‐SCT, persistent neutropenia, extensive chronic GVHD, and reactivation of cytomegalovirus. Based on the total number of these factors, patients were classified as low risk (<1 factor), intermediate risk (two factors), or high risk (>3 factors).…”

Infectious Complications After Umbilical Cord-Blood Transplantation From Unrelated Donors

“…Finally, no differences have been found in outcome after IFI, with a similar mortality rate after UCBT or transplant with other stem cell sources ranging from 7% to 86% 13,21,30,32,36,41,43…”

“…Described incidence varies among different transplantation centers depending on many factors such as the geographical region, patients diagnosis, conditioning, period of neutropenia and type of primary prophylaxis 7,12,13,14,21,30,32,36,37,39–43…”