Retrospective study of clinical predictors of positive fungal cultures in recipients of allogeneic and autologous stem cell transplantation

Ref ID: 18587

Author:

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

Author address:

Imperial College NHS trust (London, UK

Full conference title:

Annual Meeting of the EBMT, 36th

Abstract:

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
6
/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

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