Prospective surveillance for invasive fungal infection in allogeneic haematopoietic stem cell transplant (HCT): epidemiology, risk factors and outcome in a single centre

Stella Santarone*, Domenico D'Antonio, Pasqua Bavaro, Marta Di Nicola, Paolo Di Bartolomeo

Author address: 

Pescara, Chieti, IT

Abstract: 

Invasive fungal infection (IFI) has emerged as a leading cause of morbidity and mortality among HCT recipients. In this study we report an overview on the incidence of IFI by analyzing 10-year data collected prospectively on 350 consecutive patients who received an allogeneic HCT in our center between 2001 and 2011. Patient, donor and transplant characteristics are described in Table 1. We included only IFI defined as probable or proven in accordance with published guidelines. We identified 39 cases of IFI (prevalence 11,1%), of which 30 were due to invasive aspergillosis (IA) (22 probable and 8 proven (Aspergillus flavus 5, Aspergillus fumigatus 3)), 1 to Fusarium solanis infection, and 8 to Candidemia (C. albicans 3, C. krusei 4, C. parapsilosis 1). The median day of onset for IA and Candidemia was day 55 (12-3023) and day 35 (11-187) respectively, whereas the Fusariosis infection occurred on day 140 post-transplant. IA involved lung in 29 cases and brain in 1; Fusariosis involved skin and blood; Candemia occurred in blood (n=6) or in blood, liver and spleen (n=2). Imaging findings in pulmonary IA on CT scan included: macrododules > 1 cm in 13 patients, consolidation in 7, clusters of small nodules in 7, cavitary lesion in 2, and non specific ground-glass opacification in 2. The 5-yr and 10-yr cumulative incidence (CI) of IFI was 11.3% (IA 8.9%, Candidemia 2.4%) and 12.5% (IA 10.1%, Candidemia 2.4%) respectively. In univariate analysis there was no significant correlation between recipient factors (age, gender, ferritin, underlying disease, previous transplant, disease risk) or transplant factors (type and intensity of conditioning regimen, stem cell source), and occurrence of IFI, whereas the use of antithymocyte globulin (ATG) and the development of both acute and chronic graft-versus-host disease (GvHD) were significantly associated with an higher CI of IFI. In multivariate analysis we found 4 risk factors significantly associated with an higher CI of IFI: recipient age > 50 years (Hazard Risk (HR) 1.65 (p=0.05); acute GvHD (HR 1.59, p=0.01); chronic GvHD (HR 1.62, p=0.001; CMV infection (HR 1.37, p=0.003). Five of the 39 patients with IFI died for this complication, in all cases from IA. The 10-yr overall survival for the 311 patients with no evidence of IFI was 42% as compared to 17% of the 39 patients with IFI (p=0.006). These results emphasize that IFI represent a significant complication in HCT recipients.

Tables: 

2013

Full conference title: 

Annual Meeting of European Society for Blood and Marrow Transplantation
    • EBMT 39th (2013)