Introduction: Invasive fungal infections (IFIs) are a major cause of infectious morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Because of limited data, the extend of this problem in children is not clear.
Materials (or patients) and methods: We retrospectively analyzed the incidence, outcome and risk factors of IFI in the first six months after 419 allogeneic HSCT in 412 pediatric patients treated at 16 different centers in Turkey from 1st of January 2013 to 31st of December 2013.
Results: The incidence of IFI in the first six months after allogeneic HSCT in pediatric patients was 10%, consisting of possible, probable and proven IFI at rates of 4%, 2% and 4%, respectively. IFI developed in 41 patients, 33 of which within 100 days, 19 of which occurred in the first month after transplantation. Among all 419 patients, 81 (19%) died after a median 60 days following transplantation (range, 8-180 days). Among 81 patients who died, 8 died due to or associated with IFI. Overall mortality rate attributable to IFI was 2% (8/419) and IFI was responsible or co-responsible for 10% (8/81) of deaths. Although invasive mold infections (n=6 proven mold infection) appear to be more difficult to resolve (33%, 2/6) than invasive yeast infections (n=10 proven yeast infection) (80%, 8/10), the power is lacking for statistical significance. Non-relapse mortality was not significantly different for patients with IFI and those without IFI. Univariate analysis showed that second transplantation (p=0.023), unrelated donor (p=0.042), late or none lymphocyte engraftment (p=0.003), grade II-IV acute graft versus host disease (aGVHD) (p=0.002), corticosteroid dose>2 mg/kg/day for at least 10 days (p=0.021), CMV reactivation (p=0.001), ATG (p=0.001) and Fludarabine (p=0.028) were possible risk factors for IFI. Of these factors, grade II-IV aGVHD [relative risk (RR) of IFI=2.801, p=0.008], ATG (RR of IFI=3.077, p=0.009), late or none lymphocyte engraftment (RR of IFI=2.451, p=0.013), second transplantation (RR of IFI=5.555, p=0.037) and CMV reactivation (RR of IFI=2.110, p=0.046) were the factors associated with IFI in multivariate analysis.
Conclusion: The incidence and treatment success of IFI in this cohort are comparable to the rate reported in adult and other pediatric patients. Our results suggest that IFI after allogeneic HSCT in children is associated with grade II-IV aGVHD, second transplantation, CMV reactivation and late or none lymphocyte engraftment. Effective anti-fungal prophylaxis for these patients should be considered.
Full conference title:
- EBMT 41st (2015)