Clinical Analysis of Invasive Fungal Infection after Allo-Geneic Stem Cell Transplantation

Object: The study was aimed to analyze the incidence, risk factors and outcome of invasive fungal infection (IFI) in allogeneic hematopoietic cell transplantation (HSCT) recipients, and to provide evidence for the prevention and treatment of IFI.

Method: 79 patients undergoing formed HSCT at this institute from Jan 2005 to Sep 2014 with intact datum, were analyzed retrospectively according to the diagnostic criteria of IFI. The data of age, sex, primary disease, the source of stem cell, HLA-identical situation, ABO matching, conditioning regimen, use of ATG, season, aGVHD, neutropenia less than 0.5×109/L, CMV infection, etiology culture, blood routine test, imaging, relapse of disease and survival were recorded. Moreover, the data of patients with IFI including usage of glucocorticoid and the neutrophil count were recorded when IFI occurred and the blood cells count after IFI.

Result: 17 patients has been diagnosed with IFI, in which 13 cases were probable and 4 cases were possible. The infection rate was 21.5%. There were 8 female and 9 male. The median age was 26 years (6-50 years).The total non relapse survival (NRS) rate was 55.6%, The NRS rate in non-infection group was 61.2% and that in infection group was 35.2%. The single-factor analysis showed matching(x2=15.061, p=0.010) and aGVHD (x2=6.983 p=0.008) were risk factors. After IFI, 8 patients died, 2 patients got complete response, 5 patients got partial response and 2 patients got stable response. The death rate was 47%, there was significant difference between two groups. The dose of glucocorticoid before IFI within 30 days was risk factor. Multiple-factor analysis further showed Ⅱ-Ⅳ degree of aGVHD (OR=4.810 p=0.012 CI:1.406-16.459 ) and matching (OR=25 p=0.007 CI:2.380-262.653) were risk factors. Moreover, before IFI, use of methylprednisolone more than 360 mg before infection (OR=0.041 P=0.017 CI:0.003-0.56) was risk factor.

Conclusion: Patients with poor matching, unrelated stem cell and Ⅱ-Ⅳ degree of aGVHD are more likely to occur IFI and those who were used more glucocorticoid are likely to die. Therefore, avoiding the risk factors might reduce the incidence rate of IFI and respect using dose of immunosupperssor before infection within 30 days may improve the patients' prognosis.