Abstract
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.
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. | |||||||||
Incidence of post-HSCT IFI per year
Overall survival of the patients with IFI
No relevant conflicts of interest to declare.
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