Background: Nonmyeloablative conditioning regimens for allogenic haematopoietic stem cell transplantation (alloHSCT) are recent therapeutic avenues used to treat an increasing number of patients. Methods: In this retrospective study, we determined the incidence of invasive aspergillosis (IA) in alloHSCT recipients and associated risk factors. Results: Between July 2000 and December 2005, 111 patients underwent an alloHSCT with a standardised nonmyeloablative conditioning regimen at our institution. IA, defined according to the EORTC/MSG criteria, occurred in 16 patients (3 proven, 11 probable, and 2 possible cases), with a cumulative incidence rate of 7.9/100 person-year. Fourteen (87.5%) patients had previous autologous transplantation. IA occurred on average 1 year after alloHSCT (median: 7 months, range: 18722;35 months). We were able to identify 14/16 species: A. fumigatus (n = 12), A. versicolor (n = 1), and A. glaucus (n = 1). The indications for alloHSCT were: acute myeloid leukemia (n = 1), multiple myeloma (n = 11), and lymphoma (n = 4). Neutrophil counts were consistently above 0.5x 109/L for all of our patients, and 12/16 patients (75%) had already developed a chronic graft versus host disease (cGVHD) at the time of the diagnosis. Among patients with IA, crude overall mortality was 56% (9/16) with direct attributable mortality in 3 patients, compared to 23% (22/95) in recipients without IA ( p = 0.01). Conclusion: The incidence of IA in nonmyeloablative alloHSCT recipients is similar to the incidence reported in conventional alloHSCT. Infections occur late in nonmyeloablative alloHSCT. Neutropenia is not a risk factor associated with IA in this population. There is no statistically significant difference in the frequency of cGVHD between patients with and without IA.
Full conference title:
Infectious Diseases Society of America, 44th Annual Meeting
- IDSA 44th