Background: For decades infections have been among the major causes of death in patients undergoing hematopoietic stem cell transplantation (HSCT). In the era of novel diagnostic and therapeutic strategies, outcome variables should carefully be monitored and re-evaluated. Methods: In a single-center, retrospective survey data from a total of 607 adult and pediatric patients (242 allogeneic and 365 autologous graft recipients) undergoing HSCT between 2008 and 2010 were analyzed. An autopsy was performed in all fatal cases. Pathogens were identifi ed on morphological basis and culture. No nucleic acid based tests were used on tissue specimens. A possible infectious cause of deaths was investigated based on post mortem and clinical fi ndings. In cases of most prevalent infections the time to death post transplantation was also calculated. In mold infections results were compared to historical control data. Results: During the median follow-up time of 113 (1-891) days 77 (16 autografted and 61 allografted) patients died. In the autologous transplant population only 3 patients died of infection [P470]S124 (bacterial: 1, mold infection: 2). Both of these mold infection cases were heavily pretreated multiple myeloma patients dying of an invasive aspergillosis. In the allogeneic HSCT setting 33 fatalities (55% of deaths) could be related to infection. Mold: 16 (25%), bacterial: 9 (15%), viral: 7 (11%), protozoon: 1 (2%) and mold+viral double infection: 1 (2%). Compared to historical control (same centre, between 2003-2006) a non-signifi cant decrease in mold related deaths could be observed (7 vs. 8.2 % of all allogeneic HSCT cases). While the rate of invasive aspergillosis-related deaths decreased, a minor increase was seen in fatalities due to mucormycosis (4.5 vs. 6.1%, and 2.5 vs. 2% of all allogeneic HSCT cases, respectively). Time to death due to aspergillosis after HSCT was signifi cantly shorter when compared to mucormycosis (mean 98.8 vs. 178.5 days, p=0.05). Conclusions: 1. Infectious mortality remains low in autologous HSCT but infection is still a leading cause of death in the allogeneic HSCT setting. 2. Invasive mold infections can occur in pretreated and autografted multiple myeloma patients. 3. The incidence of fatal invasive aspergillosis slightly decreased in allogeneic HSCT but the rate of mucormycosis showed a tendency to increase. 4. Fatal aspergillosis occurred signifi cantly earlier post transplantation than deaths due to mucormycosis.
Full conference title:
Annual Meeting of the EBMT, 38th
- EBMT 38th (2012)