Ref ID: 18587
A. Khoder, M. Petrou, C. Thomas, R. Szydlo, E. Kanfer,
D. Marin, A. Rahemtulla, A. Luqmani, J. Hung, D. MacDonald,
D. Milojkovic, J. Apperley, K. Rezvani
Imperial College NHS trust (London, UK
Full conference title:
Annual Meeting of the EBMT, 36th
Fungal infection is a major cause of mortality in stem cell
transplantation (SCT). We retrospectively analyzed all fungal
isolates from SCT patients referred to the mycology lab for susceptibility and speciation from 1997 to 2006. During this period
760 and 455 patients underwent autologous and allogeneic
SCT for haematological malignancies respectively. Positive
isolates were reported in 78 (10%) of recipients of autologous
SCT (30 MM, 27 NHL and 22 others) and in 79 (17%) of alloSCT patients. In the latter group (45 CML, 13 acute leukaemia
and MDS, 11 others), 18 received reduced-intensity-conditioned and 61 myeloblative allografts. The donor was matched
sibling (38), matched unrelated (36) and mismatched related or
unrelated (5). Two-thirds were T- depleted. Median CD34 + cell
dose was 4.3 x 10
/kg and median time to neutrophil engraftment (TNE) was 21 d. 52% & 47% of patients with positive
isolates had grade II-IV aGvHD and moderate-severe cGvHD
respectively. Risk factors for positive isolate were aGVHD
(P = 0.03), unrelated donor (UD) (P = 0.012) and T-depletion
(P = 0.001). No signifi cant association between TNE, CD34 +
dose or conditioning and occurrence of positive isolates was
seen. There were 494 positive isolates in 157 patients (407
yeasts and 87 fi lamentous fungi, FF). Non-albicans (NA) candida accounted for 57% of all yeasts (74% C. glabrata and C.
krusei). The most frequent species leading to candidaemia
were C. glabrata (26%), C. krusei (17%) and C. albicans (17%).
In vitro 64% of NA candida were resistant to fl uconazole (FCZ).
Most C. glabrata (88%) were resistant to itraconazole (ITZ) and
35% to voriconazole (VCZ). Conversely C. albicans was invariably sensitive to FCZ or other azoles. All yeasts were sensitive
to amphotericin B (AMB) and whilst caspofungin was active
against Candida its activity against other yeasts was variable.
FF were more common in alloSCT (4.6%) than ASCT (1.4%).
The most common FF were Aspergillus species (74%), Penicillium (6%) and Fusarium (5%). In vitro no FF were inhibited
by FCZ. Here, we show that T-depletion, an UD and GvHD
increase the risk of fungal infection. C. glabrata and C. krusei
are the predominant NA candida isolates and have a signifi cant
rate of azole resistance. A fumigatus is the predominant FF.
This study is limited by its retrospective nature. We are performing prospective studies to defi ne risk factors and analyze
the impact of changing anti-fungal prophylaxis and treatment
on transplant outcome.
Abstract Number: P772
Conference Year: 2010
Link to conference website: NULL
New link: NULL
Conference abstracts, posters & presentations
C Gutierrez Perez1*, S Dhingra1,2, SM Kwansy3, TJ Opperman3, RA Cramer1
PC Chatterjee1*, WC Chiu1, EBB Burgener2, PLB Bollyky3, JH Hsu1
AS Serris1*, FU Uhel2, GMB Martin-Blondel3, OL Lambotte4, MEB Bougnoux5, EL Litvinova6, AO Ouedrani7, CR Rouzaud1, VB Bedarida8, JHR Raphalen9, FL Lanternier1,10
ZA Lewis1, RB Meagher2*, S Ambati2, X Lin1
QJ Choudhury1*, S Ambati2, X Lin1, ZA Lewis1, RB Meagher2
M James1*, KW Liu1, E Vesley1, T Hohl2, RA Cramer1
D Luptakova1, RH Patil1,2, V Havlicek1,2*
EI Matthaiou1*, W Chiu1, C Conrad2, J Hsu1
H Kamboj*, M Vijay, L Gupta, P Vijayaraghavan
S Hartung1,2*, TNM Hoang1,2*, Z Cseresnyes3*, N Schuck1, K Rennert4,5, F Klos6, AS Mosig5,7, MT Figge3,8, M von Lilienfeld-Toal1,2
* Authors 1, 2 and 3 contributed equally