Impact of previous fungal infection on the outcome of allogeneic haematopoietic stem cell transplantation: after introducing new antifungal agents

Ref ID: 18589

Author:

M. Yanagisawa, Y. Inamoto, N. Imahashi, S. Tsukamoto,
M. Adachi, M. Sawa, K. Watamoto, A. Kohno, T. Ono, H. Iida,
M. Murata, K. Miyamura, T. Naoe on behalf of the Nagoya
Blood and Marrow Transplantation (NBMTG)

Author address:

NULL

Full conference title:

Annual Meeting of the EBMT, 36th

Abstract:

A history of invasive fungal infection (IFI) has been considered
a contraindication to allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, use of new antifungal agents,
in combination with reduced-intensity conditioning regimen,
may give patients with hematological malignancy a chance to
receive allo-HSCT. To confi rm this hypothesis, we retrospectively reviewed 23 patients with a history of IFI who had undergone allo-HSCT from 1993 to 2008 in the centers of Nagoya
Blood and Marrow Transplantation Group.
Patients’ median age was 45 years (18-63 years). Twenty-two
patients had hematological malignancies. Used graft sources
were peripheral blood stem cells (n = 8), bone marrow (n = 13)
and cord blood (n = 2). Sixteen patients received fl udarabinebased reduced-intensity conditioning. Three patients were
diagnosed as proven, 8 as probable and 12 as possible IFI
before allo-HSCT. Invaded organs were liver (n = 10) and
lung (n = 11). The median onset days of the fungal diseases
were 58 days (7-280 days) before allo-HSCT. Four patients
received allo-HSCT with fl uconazole or amphotericin B syrup,
5 patients with intravenous amphotericin-B, and 14 patients
received one of following new antifungal agents: voriconazole,
micafungin and liposomal amphotericin B. On the day of alloHSCT, IFI was controlled (defi ned as afebrile and negative
of C-reactive protein ) in 16 patients, and uncontrolled in 7
patients.
After a median follow-up of 238 days (4-738 days) from the day
of allo-HSCT, 9 out of 23 patients were alive with an overall survival (OS) rate of 54% at 1 year after transplantation. Relapse
rate at 1 year was 21% and non-relapse mortality rate at 1 year
was 26%. Two deaths were related to fungal infection prior to
allo-HSCT; one patient with lung Aspergillosis died of pulmonary bleeding and the other with Candida abscess in liver died
of hepatic sinusoidal obstruction. Both of them died within 30
days after allo-HSCT.
OS at 1 year in patients with reduced-intensity conditioning
(n = 16) was signifi cantly higher than that in patients with myeloablative conditioning (n = 7) (76% versus 14%; P = .0045). OS
at 1 year tended to be higher in patients who received new
antifungal agents (n = 14) than in those who received other antifungal agents (n = 9) (71% versus 30%; P = .071).
In summary, our data suggest that a history of IFI is not necessarily a contraindication for allo-HSCT if reduced-intensity conditioning and new antifungal agents are used.

Abstract Number: P786

Conference Year: 2010

Link to conference website: NULL

New link: NULL

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