Purpose: Invasive fungal infection (IFI) is one of the leading causes of transplant-related mortality (TRM) and its incidence in allogeneic hematopoietic stem cell transplantation (HSCT) recipients varies among the reports.
Patients & Methods: Thirteen thousands five hundred twenty-two patients (7,848 males and 5,674 females) with a median age of 40-year-old (range 0-88) who underwent allogeneic HSCT for hematological diseases between January, 2006 and December, 2010 in Japan were included in this study. Data were collected and analyzed retrospectively using the Transplant Registry Unified Management Program (TRUMP) of Japan Society for Hematopoietic Cell Transplantation.
Results: The 2-year cumulative incidence of IFI after HSCT was 11.2% (696 recipients), including 289 invasive candidiasis (IC) (2.1%) and 953 invasive aspergillosis (IA) (7.1%). Among the 262 Candida isolates from IC patients, the most common species was C. parapsillosis (n = 77, 29.4%) and non-albicans Candida spp. were more commonly isolated than C. albicans (n = 32, 12.2%). Median onset of IFI was 70 (1 - 1162) days after HSCT. Risk factors which were significantly associated with the incidence of IFI were adult, male, advanced disease status, CBT, HLA-mismatched HSCT, more than one number of HSCT, reduced intensity conditioning, poor performance status at HSCT, active infectious disease at HSCT and chronic graft-versus-host disease. The 2-year cumulative incidence of IFI among patients who developed chronic graft-versus-host disease was 12.7% compared with 9.8% among patients without chronic graft-versus-host disease (p<0.0001). The recipients who developed IFI after allogeneic HSCT showed significantly poor overall survival (29.7% vs 52.3% at 2 years, p<0.0001) due to high TRM (47.5% vs 22.2% at 2 years, p<0.0001). Among them, the overall survival rate was significantly lower for patients with IC than patients with IA (25.9% vs 31.2% at 2 years, p<0.0001). Median follow-up of surviving patients was 2.2 years. The 60-day survival rate ranged from 52% for patients with IC to 70% for patients with IA.
Conclusions: IFI occurred frequently and recipients who developed IFI after HSCT, especially IC showed poor overall survival due to high TRM, even now.
Full conference title:
- EBMT 39th (2013)