Introduction: Invasive fungal infections (IFIs) are one of the most important causes of morbidity and mortality in patients submit-ted to allogeneic stem cells transplantation (SCT). Their incidence is increasing and due to the use of more intensive conditioning regimens, Graft versus Host Disease (GVHD) prophylaxis, higher frequency of Matched Unrelated Donor (MUD), alternative hemo-poietic stem cells sources and patients >55 years old. We here report on morbidity and mortality in allotransplanted patients who developed an IFI and who have been early and aggressive managed.
Materials (or patients) and Methods: This retrospective single center study includes 128 consecutive patients submitted to SCT from January 1, 2007 to December 31, 2012. 56/128 (44%) had an acute leukaemia, 25 (19%) had a lymphoma, 21 (16%) a multiple myeloma and the remaining had other onco-hematological dis-orders. The disease was advanced in 67/128 (52%) and patients conditioned with reduced intensity regimen (RIC) were 84 (66%). Thirteen patients (10%) had previous fungal infection before SCT. Antifungal prophylaxis was fl uconazole in 41 patients (84%). Our approach was an aggressive monitoring of patients with febrile neutropenia, including microbiological (e.g. Aspergillus Antigen and culture on Broncho-Alveolar Lavage) and radiological (e.g. HR CT) examination.
Results: Forty-nine (38%) patients developed an IFI. Four IFIs (8%) were classifi ed as proven, 3 (6%) as probable and 42 (86%) as possible. Proven IFIs were due to Aspergillus spp in 3 cases and Mucor in one patient. No Candida’s IFI were documented. Forty-one (84%) IFIs were diagnosed within 6 months from SCT, indicat-ing a clear relationship with conditioning regimens, neutropenia, immunosoppression and acute GVHD. First line therapy of IFIs was amphotericin b liposomal in 20 patients (41%), voriconazole in 15 (31%) and caspofungin in 14 (28%). Only 6 patients (12%) died for progression of fungal infection, the fungal free survival and over-all survival at 5 years was 88% and 55%, respectively.
Discussion: Between 2007 and 2012, the incidence of IFIs moved from 18% to 43% due to the increasing number of elderly patients, advanced status disease (44% in the 2007-2009 and 59% in 2011-2012) and the prevalence of unrelated donors’ choice. The absence of Candida IFIs was probably due to fl uconazole-based prophy-laxis, that is used routinely in this setting. Overall, only 6 deaths related to fungal infection progression were observed. This low mortality rate could be achieved thanks to an aggressive moni-toring of patients with febrile neutropenia, together with prompt initiation of antifungal therapy.Acknowledgments: This work was supported in part by Lions Club Bassa Bresciana, Banca di Credito Cooperativo di Pompiano e Franciacorta
Full conference title:
- EBMT 40th (2014)