Background: Invasive fungal infections (IFIs) are major complications after allogeneic hematopoietic stem cell transplantation (HSCT). Polymerase chain reaction- (PCR-) based assays able to detect DNA from Aspergillus and Candida species have been reported to precede clinical diagnosis of IFI, enabling pre-emptive or early treatment. We performed a prospective study to evaluate a PCR-based pre-emptive approach. Methods: Ninety-nine patients undergoing reduced-intensity conditioning (RIC) HSCT were followed once a week with fungal PCR during the fi rst 100 days post-transplantation. Patients who tested positive were randomized to treatment with liposomal amphotericin B or to no treatment. After day 100, PCR tests were performed only on clinical suspicion of IFI. Results: Forty-one patients had at least one positive PCR test (Aspergillus, n = 18; Candida, n = 29; both, n = 6). A single positive PCR test was not associated with IFI irrespective of whether or not there had been administration of pre-emptive liposomal amphotericin B. After day 100, PCR tests for Aspergillus did not contribute to diagnosis of proven or probable S223 invasive aspergillosis (IA). The cumulative incidence rates of proven or probable IFI, IA, and invasive candidiasis during the fi rst year after transplantation were 12%, 9%, and 2%, respectively. Acute graft-versus-host disease (GVHD) of grades II CIV (P = 0.0014), CMV-seronegative recipient with CMV-seropositive donor (P8804; 0.001), and conditioning with alemtuzumab (P = 0.014) were signifi cant risk factors for developing IA in a multivariate model. Conclusions: PCR of peripheral blood is a poor predictor of invasive fungal infection after allogeneic HSCT.
Full conference title:
Annual Meeting of the EBMT, 36th
- EBMT 36th (2010)