Background: Advances in allogeneic HSCT over the last decade have reduced organ damage, infection and acute GVHD. With improved diagnostics and antifungal treatment, we hypothesized that invasive mold infections (IMIs) prior to allo-HSCT would no longer represent a signifi cant risk factor for patient death after transplant. Methods: We identifi ed AML or MDS patients who developed an IMI documented by MSG/EORTC criteria prior to allogeneic HSCT at M.D. Anderson Cancer Center during 2005-2008. We collected data on the transplant procedure and complications, co-morbidities and infections. Variables screened by univariate analysis were fi tted to a multivariate regression models to assess independent risk factors associated fungal relapse and survival. Results: 60 patients were identifi ed (52 AML, 8 MDS). Most had active (30%) or refractory (53%) leukemia at the time of allo-HSCT and received mold-active secondary prophylaxis (54%). Most IMIs were not microbiologically documented (58%). The most common documented IMIs were Aspergillus (23%), Mucorales (8%), Curvularia (3%) and Fusarium (2%). Treatment for the IMI prior to transplant included combination (66%); single agent (29%) or triple drug regimens (5%), which consisted of triazole-echinocandin combinations (28%); lipid amphotericin B (LAMB)-echinocandin (23%), LAMB monotherapy (17%), LAMB-triazole (15%), or triazole montherapy (10%). Most patients had complete (62%) or partial (15%) response to treatment prior to transplant, with fewer patients exhibiting evidence of stable disease (13%) or progression (7%) on therapy. Most patients with prior IMIs (73%) did not develop a recurrent or new infection after transplant, whereas 12% of patients relapsed, 10% failed secondary prophylaxis, and 5% developed a breakthrough infection. Risk factors for recurrent infection included poor response of initial IMI (P=0.03) and TNF-302; inhibitor therapy (P=0.001). Secondary prophylaxis modestly reduced the risk of recurrent IMI (P=0.07). Survival at 6 months (64%) and 1 year (57%) was similar in all patient groups. Status of the underlying malignancy was the most important factor infl uencing 1 year survival (OR 1.5; 95% CI 0.94-2.5; P=0.08). Conclusions: Most patients with prior IMIs did not develop evidence of relapsed IMI following allogeneic HSCT, especially if they had good response to initial treatment. Our data suggest that prior IMI should only be considered a "œsoft contraindication" to subsequent allo-HSCT.
Full conference title:
Annual Meeting of the EBMT, 37th
- EBMT 37th (2011)