Prior invasive mould infections are not a major risk factor for death in patients who undergo allogeneic haematopoetic stem cell transplantation

Ref ID: 18610

Author:

L. Best (1), R. Lewis (2), D. Kontoyiannis (1)

Author address:

(1)The University of Texas (Houston, US); (2)University of
Houston (Houston, US)

Full conference title:

Annual Meeting of the EBMT, 37th

Abstract:

Background: Advances in allogeneic HSCT over the last decade have reduced organ damage, infection and acute GVHD.
With improved diagnostics and antifungal treatment, we hypothesized that invasive mold infections (IMIs) prior to allo-HSCT
would no longer represent a signifi cant risk factor for patient
death after transplant.
Methods: We identifi ed AML or MDS patients who developed
an IMI documented by MSG/EORTC criteria prior to allogeneic
HSCT at M.D. Anderson Cancer Center during 2005-2008. We
collected data on the transplant procedure and complications,
co-morbidities and infections. Variables screened by univariate analysis were fi tted to a multivariate regression models to
assess independent risk factors associated fungal relapse and
survival.
Results: 60 patients were identifi ed (52 AML, 8 MDS). Most
had active (30%) or refractory (53%) leukemia at the time of
allo-HSCT and received mold-active secondary prophylaxis
(54%). Most IMIs were not microbiologically documented
(58%). The most common documented IMIs were Aspergillus
(23%), Mucorales (8%), Curvularia (3%) and Fusarium (2%).
Treatment for the IMI prior to transplant included combination
(66%); single agent (29%) or triple drug regimens (5%), which
consisted of triazole-echinocandin combinations (28%); lipid
amphotericin B (LAMB)-echinocandin (23%), LAMB monotherapy (17%), LAMB-triazole (15%), or triazole montherapy
(10%). Most patients had complete (62%) or partial (15%)
response to treatment prior to transplant, with fewer patients
exhibiting evidence of stable disease (13%) or progression
(7%) on therapy. Most patients with prior IMIs (73%) did not
develop a recurrent or new infection after transplant, whereas
12% of patients relapsed, 10% failed secondary prophylaxis,
and 5% developed a breakthrough infection. Risk factors for
recurrent infection included poor response of initial IMI (P=0.03)
and TNF-302; inhibitor therapy (P=0.001). Secondary prophylaxis
modestly reduced the risk of recurrent IMI (P=0.07). Survival
at 6 months (64%) and 1 year (57%) was similar in all patient
groups. Status of the underlying malignancy was the most
important factor infl uencing 1 year survival (OR 1.5; 95% CI
0.94-2.5; P=0.08).
Conclusions: Most patients with prior IMIs did not develop evidence of relapsed IMI following allogeneic HSCT, especially if
they had good response to initial treatment. Our data suggest
that prior IMI should only be considered a “œsoft contraindication”
to subsequent allo-HSCT.

Abstract Number: P761

Conference Year: 2011

Link to conference website: NULL

New link: NULL

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