title: Invasive fungal infections after allogeneic peripheral blood stem cell transplantation: incidence and risk factors in 395 patients.
abstract: We have analysed the incidence and risk factors for the occurrence of invasive fungal infections (IFI) among 395 recipients of an allogeneic peripheral blood stem cell transplantation (PBSCT) from a human leucocyte antigen (HLA)-identical sibling. IFI (n = 50) occurred in 46 patients, giving an overall probability of 14%. There were 12 cases of invasive candidiasis (3%), with only one death. Non-Candida IFI occurred in 37 patients (12% probability), mostly invasive aspergillosis (n = 32). In multivariate analysis the only two significant variables associated with a higher risk of developing a non-Candida IFI were the development of moderate-to-severe graft-versus-host disease (GvHD, P < 0.0001; OR 4.6) and having received steroid prophylaxis for GvHD (P = 0.04; OR 2.1). In multivariate analysis the variables associated with a lower overall survival after PBSCT were development of a non-Candida IFI (P < 0.0001; OR 5.6), non-early disease phase (P = 0.0001; OR 1.9), steroid prophylaxis (P = 0.02; OR 1.4), moderate-to-severe GvHD (P = 0.01; OR 1.6) and cytomegalovirus infection post transplant (P = 0.001; OR 1.8). Our results show that non-Candida IFI (in particular aspergillosis) was an important cause of infectious morbidity and mortality after an HLA-identical sibling PBSCT, while invasive candidiasis was rare. Use of steroid prophylaxis and, in particular, the development of moderate-to-severe GvHD post transplant were risk factors for non-Candida IFI. Prophylactic strategies for these infections should thus take into account these risk factors.
authors.affiliation: Division of Clinical Hematology, Hospital de la Sant Creu i Sant Pau, Barcelona, Spain. rmartino@hsp.santpau.es
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Martino
authors.forename: Maricel
authors.initials: M
authors.lastname: Subirá
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rovira
authors.forename: Carlos
authors.initials: C
authors.lastname: Solano
authors.forename: Lourdes
authors.initials: L
authors.lastname: Vázquez
authors.forename: Guillermo F
authors.initials: GF
authors.lastname: Sanz
authors.forename: Alvaro
authors.initials: A
authors.lastname: Urbano-Ispizua
authors.forename: Salut
authors.initials: S
authors.lastname: Brunet
authors.forename: Rafael
authors.initials: R
authors.lastname: De la Cámara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000150:complications* / Q000401:mortality; D002177:Candidiasis / Q000150:complications* / Q000401:mortality; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use; D006086:Graft vs Host Disease / Q000150:complications; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality; D006801:Humans; D015994:Incidence; D007938:Leukemia / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D008223:Lymphoma / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000382:microbiology / Q000401:mortality / Q000628:therapy*; D011183:Postoperative Complications; D012307:Risk Factors; D014184:Transplantation, Homologous
chemical_list: D005938:Glucocorticoids