Author:

Ostrosky-Zeichner L, Rex JH

Date: 3 October 2002

Abstract:

San Diego, Sunday, September 29, 2002 — There is no doubt that bone marrow transplant (BMT) and peripheral blood stem cell transplant (PBSCT) have revolutionized medicine, greatly improving outcomes of patients with several hematologic and nonhematologic malignancies, as well as other diseases. However, these strategies are not free of problems. Patients trade off certain morbidities for others; among the worst are graft-vs-host disease (GVHD) and an increased incidence of life-threatening infections. The presence of GVHD itself increases the risk of infection, both by its immunopathogenesis and by the intense immunosuppression that surrounds its management.[1] Two examples of the infectious problems that these patients face were presented at the clinical mycology slide session of the 42nd ICAAC.Nonmyeloablative allogeneic PBSCT is a relatively new therapeutic modality, which has the advantage of shorter duration of neutropenia. T.J. Walsh, MD,[2] from the National Cancer Institute, presented the results of a survey of invasive fungal infections (IFIs) that complicate this procedure. Researchers analyzed the course of 48 cases transplanted from 1997-1999 in the NIH clinical center. Cases of IFI were identified using the EORTC/MSG criteria. There were 12 episodes of IFI in 11 patients (23%) out of the 48 analyzed. IFIs were caused either by Aspergillus spp. (69%) or Candida spp. (31%). All of the infections developed in the postengraftment period, and the most important risk factors were high-grade GVHD, use of steroids, and non-CMV viral respiratory infections.F.M. Marty, MD,[3] from Brigham and Women’s Hospital in Boston, Massachusetts, presented an observation of fungal complications of patients undergoing a particular therapy for GVHD. Infliximab is a TNF-alpha blocker that is used for the treatment of rheumatoid arthritis and Crohn’s disease.[4] It is occasionally used off-label for the management of GVHD,[5] and it has been associated with increased incidence of infection, such as mycobacterial disease.[6] Researchers conducted a retrospective review of 270 allogeneic BMT patients from 2000-2001. Eleven patients received infliximab for the treatment of severe GVHD. There were 16 episodes of IFI, 10 of which occurred in the group with severe GVHD. Six of the infliximab patients developed IFI. The risk of developing an IFI in severe GVHD patients who received infliximab was significantly higher (RR 5.59, 95% CI 1.91-16.4, P = .003) than for those patients in the same risk group who did not receive it.Knowledge of the risk factors and types of patients at risk for IFI will allow scientists to identify groups in which antifungal prophylaxis is useful and warranted.[7]

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