Prognostic Factors for Death Due to Invasive Aspergillosis after Hematopoietic Stem Cell Transplantation: A 1-Year Retrospective Study of Consecutive Patients at French Transplantation Centers
Author:
Catherine Cordonnier, Patricia Ribaud, Raoul Herbrecht, Noe l Milpied, Dominique Valteau-Couanet, Caroline Morgan, and Amath Wade
Date: 5 March 2006
Abstract:
Background. Invasive aspergillosis (IA) is a major cause of death after hematopoietic stem cell transplantation(HSCT). The goal of this retrospective and consecutive survey was to assess prognostic factors of death due to IAafter HSCT at the time of diagnosis of IA.Methods. All 64 health care centers affiliated with the Socie´te´ Franc¸aise de Greffe de Moelle et de The´rapieCellulaire were contacted to participate in this study of all proven or probable cases of IA that occurred amongHSCT recipients in 2002. Data for 51 cases (41 involving allogeneic HSCT and 10 involving autologous HSCT)were collected from patient records and included diagnostic and therapeutic features of IA, outcome, presence ofhematological disease, and transplantation data. Cox models were applied to risk factors for death attributed toIA that were initially identified using the usual tests.Results. The proportion of deaths attributed to IA within 4 months after diagnosis was 0.62 (95% confidenceinterval, 0.47-0.76). Seven factors assessed at diagnosis were determined to be strongly related to death due to IA:age of 12-35 years, dissemination of IA, presence of a pleural effusion, monocyte count of !120 cells/mm3, prolongedadministration of steroids within the previous 2 months, receipt of a dose 2 mg/kg at the time of diagnosis,and uncontrolled graft-versus-host disease.Conclusions. Our study explored potential risk factors for death due to IA among HSCT recipients as areference for investigation in larger future studies. These factors should help to identify HSCT recipients whowould benefit from more-aggressive antifungal therapies.
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