To investigate the incidence and risk factors for the occurrence of proven or probable invasive fungal infection (IFI) in adult patients receiving allogeneic hematopoietic stem cell transplantation (HSCT), 421 patients undergoing HSCT between 2002 and 2013 in our hospital were retrospectively analyzed. Thirty-one patients with the median age of 42 years (range: 19-60) developed IFI after HSCT. The post-HSCT IFI incidence was 7.4% and median time from HSCT to the diagnosis of IFI was 139 days (range: 2-1809). The risk factors for the occurrence of IFI were analyzed using Cox regression models.Of the pretransplant factors, European Group for Blood and Marrow Transplantation (EMBT) risk>2 (P=0.001) and prior history of IFI (P=0.006) or DM (P=0.042) were the significant predictors for post-HSCT IFI by univariate analyses. In multivariate analysis, EMBT risk>2 (P=0.015) and prior history of IFI (P=0.006) retained significance. Of the post-transplant factors, acute graft-versus-disease (aGVHD) overall grade III-IV (P<0.001), extensive chronic GVHD (cGVHD) (P=0.002), post-transplant lymphoproliferative disorders (PTLD) (P=0.005) and the use of high-dose steroids (P<0.001) were statistically significant in univariate analyses. After multivariate analysis, high-dose steroids (P<0.001) and aGVHD overall grade III-IV (P=0.045) retained significance. These results suggest that risk group stratification prior HSCT and monitoring of IFI in patients with severe GVHD and receiving high-dose steroids is mandatory to decrease the risk of post-HSCT IFI, especially in those with prior history of IFI.

Abstract 2476. Table 1.

Possible factors for the occurrence of invasive fungal infection (IFI) after adult allogeneic HSCT

  
IFI 
Univariate analysis 
Multivariate analysis 
Factors No. of patients N % HR 95%CI P-value HR 95%CI P-value 
EMBT risk          
=<2 169 5 2.9       
>2 252 26 10.3 5.038 1.930-13.151 0.001 3.390 1.273-9.029 0.015 
Prior history IFI          
No 406 27 6.6       
Yes 15 4 26.6 4.457 1.551-12.806 0.006 5.807 1.675-20.129 0.006 
Prior history DM          
No 402 28 6.9       
Yes 19 3 15.7 3.490 1.045-11.653 0.042    
aGVHD          
No or Overall Gr. I-II 379 23 6.0       
Gr. III-IV 42 8 19.0 6.936 3.046-15.796 <0.001 2.627 1.023-6.748 0.045 
High steroids*          
No 367 12 3.2       
Yes 54 19 35.1 11.148 5.401-23.008 <0.001 11.185 3.875-32.289 <0.001 
cGVHD          
No or limited 364 19 5.2       
Extensive 57 12 21.0 3.131 1.518-6.459 0.002    
PTLD          
No 405 27 6.6       
Yes 16 4 25 4.627 1.607-13.320 0.005    
Abbreviations: CI = confidence interval; HR = hazard ratio; EBMT = European Group for Blood and Marrow Transplantation; HSCT = hematopoietic stem cell transplantation; GVHD = graft-versus-host disease; aGVHD = acute GVHD; cGVHD = chronic GVHD; Gr.= grade; PTLD = Post-transplant lymphoproliferative disorders. DM = Diabetes mellitus. High steroids* = post-HSCT high-dose steroid; Significant values (P<0.05) are given in bold. 
  
IFI 
Univariate analysis 
Multivariate analysis 
Factors No. of patients N % HR 95%CI P-value HR 95%CI P-value 
EMBT risk          
=<2 169 5 2.9       
>2 252 26 10.3 5.038 1.930-13.151 0.001 3.390 1.273-9.029 0.015 
Prior history IFI          
No 406 27 6.6       
Yes 15 4 26.6 4.457 1.551-12.806 0.006 5.807 1.675-20.129 0.006 
Prior history DM          
No 402 28 6.9       
Yes 19 3 15.7 3.490 1.045-11.653 0.042    
aGVHD          
No or Overall Gr. I-II 379 23 6.0       
Gr. III-IV 42 8 19.0 6.936 3.046-15.796 <0.001 2.627 1.023-6.748 0.045 
High steroids*          
No 367 12 3.2       
Yes 54 19 35.1 11.148 5.401-23.008 <0.001 11.185 3.875-32.289 <0.001 
cGVHD          
No or limited 364 19 5.2       
Extensive 57 12 21.0 3.131 1.518-6.459 0.002    
PTLD          
No 405 27 6.6       
Yes 16 4 25 4.627 1.607-13.320 0.005    
Abbreviations: CI = confidence interval; HR = hazard ratio; EBMT = European Group for Blood and Marrow Transplantation; HSCT = hematopoietic stem cell transplantation; GVHD = graft-versus-host disease; aGVHD = acute GVHD; cGVHD = chronic GVHD; Gr.= grade; PTLD = Post-transplant lymphoproliferative disorders. DM = Diabetes mellitus. High steroids* = post-HSCT high-dose steroid; Significant values (P<0.05) are given in bold. 
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Figure 1
Figure 1. Incidence of post-HSCT IFI per year
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Incidence of post-HSCT IFI per year

Figure 1
Figure 1. Incidence of post-HSCT IFI per year
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Incidence of post-HSCT IFI per year

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Figure 2
Figure 2. Overall survival of the patients with IFI
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Overall survival of the patients with IFI

Figure 2
Figure 2. Overall survival of the patients with IFI
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Overall survival of the patients with IFI

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Disclosures

No relevant conflicts of interest to declare.

Topics:
systemic mycosis, hematopoietic stem cell transplantation, steroids, graft-versus-host disease, chronic, graft-versus-host disease, posttransplant lymphoproliferative disorder, transplantation, allogeneic hematopoietic stem cell transplant, bone marrow transplantation, lymphoproliferative disorders

Author notes

*

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© 2014 by The American Society of Hematology
2014
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