Risk factors for fungal pulmonary infections in hematopoietic stem cell transplantation recipients: the role of iron overload

Abstract

Fungal pulmonary infections (FPIs) are frequent causes of mortality in hematopoietic stem cell transplantation (HSCT) recipients. Determination of the specific risk factors may improve the prognosis. The aim of this study was to evaluate the risk factors of FPIs due to HSCT. Patient history, physical examination, chest X-rays and the consultation records of the pulmonary disease department which were a part of the routine evaluation before and at first, third, sixth, ninth and twelfth months of HSCT were retrieved in 148 adult HSCT recipients. Results of the highresolution computed tomography, fiber-optic bronchoscopy and the microbiological data were also included. FPI was diagnosed in 22 patients (14.9%). Multivariate analysis showed that increased ferritin levels (41000 ng/ml; OR: 3.42, 95% CI 1.03-11.42, P ¼ 0.045) and the development of sinusoidal obstruction syndrome (SOS; OR: 5.09, 95% CI 1.53-16.90, P ¼ 0.008) were significant risk factors for FPIs. The sensitivity and specificity of ferritin 41000 ng/ml for the prediction of FPIs were 67 and 70%, respectively. There was a positive correlation between the increased risk of FPIs and pretransplantation ferritin levels (r ¼ 0.413, Po0.001) and increased ferritin levels and SOS (r ¼ 0.331, Po0.001). Increased pretransplantation ferritin levels and development of SOS are predictive factors of FPIs during HSCT.

Invasive fungal infection in allogeneic hematopoietic stem cell transplant recipients: single center experiences of 12 years

“…Multiple factors reported to be associated with the risk of IFI include donor type, conditioning regimens, prolonged neutropenia, GVHD, and highdose corticosteroids (Fukuda et al, 2003;Thursky et al, 2004;Ozyilmaz et al, 2010;Omer et al, 2013). According to our data, we found similar risk factors infecting IFI.…”

“…Previously identified risk factors of IFI include donor type, GVHD, high-dose corticosteroids, increased ferritin levels, and so on (Fukuda et al, 2003;Thursky et al, 2004;Ozyilmaz et al, 2010;Omer et al, 2013). Epidemiology and risk factors of IFI differ due to the changes in antifungal prophylaxis and treatment in different regions.…”

Efficacy and safety of oral deferasirox treatment in the posttransplant period for patients who have undergone allogeneic hematopoietic stem cell transplantation (alloHSCT)

“…Complications related to IO might increase transplant-related mortality in allo-stem cell transplant patients [16]. These complications are posttransplant bacterial, fungal, and viral infections [17][18][19][20], mucositis [21], liver dysfunction [22], sinusoidal obstruction syndrome [23,24], and acute GVHD [25,26]. IO may also present an exacerbation of hepatic GVHD after alloHSCT [27], so a liver biopsy may be useful for differential diagnosis in these circumstances [28].…”

Risk factors for invasive pulmonary fungal infection in patients with hematological malignancies not receiving hematopoietic stem cell transplant

“…However, risk factors for IPFI are seldom investigated for patients with hematological malignancies, and most investigations that do occur were focused on patients receiving HSCT [8][9][10]. Some patients with hematological malignancies who have not received HSCT still develop IPFI, even they were not identified as having any of the risk factors.…”