title: High rate of invasive fungal infections following nonmyeloablative allogeneic transplantation.
abstract: Nonmyeloablative allogeneic transplantation is an emerging therapy for hematologic and solid malignancies and potentially offers patients reduced transplant-related toxicity. Data regarding infectious complications of these protocols are limited, but early studies have demonstrated little infectious morbidity, particularly low rates of invasive fungal infections (IFIs). In the present study, 31 consecutive cases of nonmyeloablative transplantation were reviewed over a 2.5-year period, with a specific focus on infectious complications. Twenty-six patients (84%) had at least 1 significant infection during the year after transplantation, and infection-related mortality was 37%. Cytomegalovirus end-organ disease was diagnosed in 3 patients (10%). Ten patients (32%) were given the diagnosis of IFI; 7 (23%) met criteria for proven IFI. Fungal-related mortality was 80% within the group of patients with IFI and accounted for a significant portion of the overall mortality in the study. Severe graft-versus-host disease, high-dose corticosteroid use, recurrent neutropenia, and relapsed or refractory disease were factors associated with development of IFI.
authors.affiliation: Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-4283, USA.
authors.forename: Elisabeth A
authors.initials: EA
authors.lastname: Hagen
authors.forename: Hillary
authors.initials: H
authors.lastname: Stern
authors.forename: David
authors.initials: D
authors.lastname: Porter
authors.forename: Kathleen
authors.initials: K
authors.lastname: Duffy
authors.forename: Karen
authors.initials: K
authors.lastname: Foley
authors.forename: Selina
authors.initials: S
authors.lastname: Luger
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Schuster
authors.forename: Edward A
authors.initials: EA
authors.lastname: Stadtmauer
authors.forename: Mindy G
authors.initials: MG
authors.lastname: Schuster
mesh_terms: D000328:Adult; D000368:Aged; D018890:Chemoprevention; D005260:Female; D005334:Fever / Q000209:etiology; D006086:Graft vs Host Disease; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D009503:Neutropenia / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D014184:Transplantation, Homologous / Q000009:adverse effects*; D016896:Treatment Outcome