Invasive fungal infection following allogenic haematopoietic stem cell transplantation adult versus children (single- centre experience)

Ref ID: 18585

Author:

M. Popova, N. Zubarovskaya, V. Vavilov, A. Volkova,
M. Averjanova, N. Klimko, B. Afanasyev

Author address:

I.P. Pavlov State Medical University (St. Petersburg, RU)

Full conference title:

Annual Meeting of the EBMT, 36th

Abstract:

Background: Invasive fungal infection (IFI) is a common cause
of morbility and mortality in patients undergoing HSCT. Only
25% IFI diagnosed while alive.
The aim. To compare incidence, risk factors of IFI in adults and
children after allogenic (allo), haploidentical (haplo) HSCT.
Patients: 236 patients (pts) were enrolled between 2000 and
2009. The adult group was 106 pts, age 21-68 (median 33 y.o.),
the children group 130 pts, age 1-21 (median 14 y.o.) suffered from acute leukemias – 167, myelo- and lymphoproliferative disorders – 31, lymphomas – 18, inherent disorders – 8,
others – 12. At the moment of HSCT in remission were 144,
in relapse – 92. The most pts were received allo-HSCT as
salvage therapy. Type of the donor: MRD – 130, MURD – 97,
haploidentical donor – 9. MAC used in 85, RIC in 151. Sources
of HSC: PBSC-154, BM-71, BM + PBSC-11. Median CD34 +
– 3-8 x 10
6
/kg. Acute GvHD prophylaxis was CsA + short course
of MTX or tacrolimus + MMF, plus ALG-60 mg/kg for MUD and
haplo-HSCT.
Results: The incidence of IFI following allo-HSCT was 32%. Possible IFI was detected in 30 (40%), probable IFI in 40 (53,4%)
and proven IFI in 5 (6,6%) according to the international defi nition criteria EORTC/MSG 2008. Median date of IFI onset was
D + 68 (1-940). The main causes of IFI were Aspergillus spp.
94%, Candida spp. 3%, Cryptococcus spp. 4%. The following risk factors were detected: in adults – usage of RIC, ATG,
development of mucositis (P < 0,05); in children - age older 10 years, mucositis IV, extensive chGvHD (P < 0,05). The multivariate analyses revealed the synergistic effect of the following risk factors: in children - combination of MUD, MAC, and CMV-reactivation; MUD, RIC, relapse and BM as a source of HSCT. In adults - MUD, RIC and CMV-reactivation; MUD, RIC, remission and PBSC (P < 0,05). There were no cases of IFI in pts with inherent disease. Overall survival (OS) in pts undergoing HSCT with IFI versus without IFI was 18% vs. 55% (children) and 30% vs. 30% (adult). Twelve-weeks OS children vs. adult was 60% vs. 45%. Conclusions: We revealed difference of risk factors of IFI in children and adult and in OS in pts with IFI. The main risk factors for children are age older 10 years, mucositis IV, extensive chGvHD, for adults - usage of RIC, ATG, development of mucositis.

Abstract Number: P769

Conference Year: 2010

Link to conference website: NULL

New link: NULL

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