Predictors of invasive fungal infection in pediatric allogeneic hematopoietic SCT recipients

Abstract

This study was aimed at finding predictors of invasive fungal infection (IFI) after pediatric allogeneic hematopoietic SCT (HSCT). All children who received allogeneic HSCT in the Wilhelmina Children's Hospital Utrecht between 2004 and 2012 were included. HSCT data were prospectively collected. Patients were retrospectively classified into high-or low-risk groups for developing IFI using criteria based on available literature. Predictors for the occurrence of IFI were analyzed using Cox regression models. We used logistic regression models to analyze the association between other HSCT-related complications and IFI. Secondary outcomes were overall survival and treatment-related mortality (TRM). Two-hundred nine patients were included in the analysis; median age was 6.6 years. The cumulative incidence of IFI was 12%. In patients classified as 'low risk' (n ¼ 75), only 5.3% developed IFI (odds ratio (OR): 0.325; P ¼ 0.047). In multivariate analysis, a predictor for the occurrence of IFI was an a priori determined HSCT TRM risk 420% (based on EBMT-risk score). Post-HSCT, the administration of high-dose steroids was associated with IFI (OR: 4.458; P ¼ 0.010). Patients who developed IFI showed an increased risk of TRM (OR: 3.773; P ¼ 0.004). These results confirm that risk group stratification should guide intensity of monitoring for IFI and use of antifungal prophylaxis.

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

“…We may hypothesize that effective prophylaxis could be valuable also for this subset of patients. 24 Concerning the univariate analysis of prognostic factors, our findings were consistent with other studies showing that corticosteroid dosage, aGVHD, cGVHD and CMV infection could increase the risk of post-engraftment or late IFD. 1,5 In addition, we found that post-engraftment IFD was associated with several risk factors that have been previously related with early or overall IFD, such as older age, delayed neutrophil engraftment, previous SCT, HLA mismatch and non PBSCT.…”

Infection profile in children and adolescents with bone marrow failures treated with allogeneic hematopoietic stem cell transplantation

“…Incidence of FI after HCT in analyzed patients was 8.2%, which is in line with presented studies, where it ranged from 8% to 25% . According to Dvorak et al analysis, the incidence of proven or probable FI in pediatric patients during the first year after allogeneic HCT was 13%, which was comparable to the rate reported in adult patients …”

Early bacterial and fungal infection in children receiving allogeneic stem cell transplantation for acute lymphoblastic leukemia in Argentina

“…However, most of the fungal infections in our study were due to Candida spp., which is a contrast to many reports from high‐income countries where Aspergillus spp. may be more prevalent . This difference in distribution may be the consequence of difficulties in the diagnosis of mold infections in low‐ and middle‐income countries due to the low sensitivity of available tests and specific resources, although we did implement routine galactomannan testing and attempted to biopsy suspicious lesions whenever feasible .…”