Invasive aspergillosis following haploidentical haematopoietic stem cell transplantation. A single-centre experience

Ref ID: 18554

Author:

M. Bouzani (1), S. Kühn (1), M. Dittrich (2), T. Müller (2),
M. Kapp (1), G.U. Grigoleit (1), S. Mielke (1), H. Einsele (1),
J. Löf64258; er (1)

Author address:

(1)University Hospital Würzburg (Würzburg, DE); (2)University
of Würzburg (Würzburg, DE)

Full conference title:

Annual Meeting of the EBMT, 38th

Abstract:

Invasive aspergillosis (IA) is a major cause of morbidity and
mortality among patients undergoing HHSCT. The aim of our
study is to identify factors related to the occurrence and the outcome of IA in this patient cohort. Between 2005 and 2010, 33
(M:F 22:11) patients received a HHSCT. Their median age was
52 years (range 17-69). All patients were heavily pre-treated
(12 had previously undergone autologous transplantation) due
to primary resistant haematological malignancies and/or early
disease relapse. Four patients had a previous invasive fungal
infection. Graft donors (M:F 27:7) had a median age of 41 years
(range 21-67). High resolution HLA typing was available for 28
cases. Among them, in 12, the donor-recipient HLA combinations predicted NK cell alloreactivity against the HLA type of the
patient. All conditioning regimens were Fludarabine based. All
patients received peripheral blood stem cells. Eight grafts were
obtained after selection of CD34+ cells, 24 after depletion of
CD3+/CD19+ cells and 1 after both procedures. The median
number of cells was: CD34+ 5.33E+06/Kg, CD3+ 3.8E+04/Kg,
CD19+ 3E+04/Kg, NK 2.3E+08/Kg. Seventeen patients received prophylaxis against aGvHD. Six developed aGvHD grade
II-III and 27 grade 0-I. The data of the HHSCT were compared
to those from 39 patients who received graft from a matched
sibling donor (control group).
The median survival in HHSCT recipients was 115 days (range
3-1198). Data for the occurrence of IA were available for 21
out of 33 patients. Based on the EORTC criteria, 15 cases
were characterized as negative or possible and 6 as probable
or proven (28%). Between these 2 groups there was no signi-
fi cant difference on survival, on acute GvHD development and
on the presence of KIR alloreactivity. The numbers of NK and
T cells in the graft were not signifi cantly different. However, it
was observed a trend of a higher number of CD34+ cells correlated with a lower incidence of IA (p< 0.1). A lower incidence of IA was observed in the control group (5 probable cases, 12%). Interestingly, the occurrence of IA in the later was correlated with a reduction of survival (p<0.015). HHSCT is a complex, high risk procedure, where numerous parameters contribute to morbidity and mortality. This might explain the different impact of IA between the HHSCT and control group, which undergoes a lower risk procedure. In any case, larger cohorts of patients enrolled in prospective studies might identify factors correlating with IA.

Abstract Number: P481

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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