Risk factors and prognosis of invasive fungal infections in allogeneic stem cell transplantation recipients: a single-institution experience

Abstract

Post-transplant IFI was an unfavorable prognostic factor of the SCT recipients, and risk stratification can identify patients with high risk of IFI. Use of steroid played an important role in the pathogenesis as well as prognosis of IFI.

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

“…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. 3,4 Our data suggest that ATG-containing regimens could increase the risk of IFD, which is in line with other studies reporting ex vivo T-cell depletion using Cl of IFD alemtuzumab as a risk factor for IFD.…”

“…(4 patients), A. fumigatus (3), A. flavus (1) and Criptococcus spp. (1). The NRM at 6 and 12 months among patients who developed IFD was 12 and 40%, respectively, while patients without IFD had 9 and 16%, respectively (P o0.0001).…”

“…1,2 Many studies, mainly from single-institution retrospective series, have analyzed the incidence and risk factors of these infections after alloSCT, 1,3-5 reporting a variable incidence ranging from 1 to 20%. 6,7 It is well established that severe neutropenia induced by conditioning regimens is associated with an increased risk of developing IFD after alloSCT, and it is generally accepted that antifungal prophylaxis should be administered in the pre-engraftment period.…”

“…This study aims (1) to retrospectively analyze the incidence, outcome and risk factors of IFD after myeloid engraftment in a large series of consecutive adult patients submitted to alloSCT in a single institution, (2) to assess the impact of primary antifungal prophylaxis with oral drugs (itraconazole and low-dose voriconazole) on occurrence of post-engraftment IFD and (3) to construct a scoring system that could be useful to improve risk-adapted prophylaxis strategies with antifungal agents for patients discharged after engraftment.…”

The risk of infections in hematologic patients treated with rituximab is not influenced by cumulative rituximab dosage - a single center experience

“…In a multicenter trial evaluating the effect of high-dose dexamethasone versus low-dose dexamethasone in combination with lenalidomide for first-line myeloma treatment there was a significant increase in infectious complications for patients in the high-dose steroid group, underlining the influence of steroid dosage when added to another potentially immunosuppressive therapeutic regimen [28]. Especially for opportunistic infectious pathogens like Aspergillus spp., high dose steroids are a major independent factor for invasive aspergillosis and also confer an inferior prognosis in hematologic patients after allogeneic transplantation [29]. Furthermore, they are an independent risk factor for IA even for otherwise non-immunocompromised patients [30]: In a recent analysis [31] the majority of hematologic patients treated with rituximab with Pneumocystis jirovecii pneumonia had high-dose glucocorticoid exposure, underlining the pronounced effect of steroid co-medication in the pathogenesis of opportunistic infections.…”