Invasive fungal infections in autologous stem cell transplant recipients: a nation-wide study of 1188 transplanted patients.
Based on small single-centre series, the risk of invasive fungal infections (IFI) has been considered small in autologous stem cell transplant (ASCT) recipients.


OBJECTIVE
To analyse epidemiological and clinical features of (IFI) among ASCT recipients in Finland 1990-2001.


METHODS
During the study period, 1188 adult patients received high-dose therapy supported by ASCT in six centres. Altogether, 1112 patients (94%) received blood progenitor cells. The graft was CD34+ selected in 261 patients (22%). The major diagnostic groups were non-Hodgkin's lymphoma (n = 417), multiple myeloma (n = 395), breast cancer (n = 132) and Hodgkin's lymphoma (n = 53).


RESULTS
Eighteen patients (1.5%) with IFI were identified. The incidence of proven or probable invasive aspergillosis was 0.8%, followed by candidaemia with an incidence of 0.3%. The median time to the diagnosis of IFI was 35 d (6-162) from the progenitor cell infusion. In fourteen patients (78%) IFI was diagnosed during lifetime and they were treated with antifungal therapy for a median of 50 d. Nine patients (64%) were cured.


CONCLUSIONS
IFI appears to be a rare event after ASCT and Aspergillus infections seem to be predominant. These epidemiological features have an impact in planning prophylactic and empirical antifungal strategies in ASCT recipients.
Department of Medicine, Kuopio University Hospital, Finland. esa.jantunen@kuh.fi
E
E
Jantunen
J
J
Salonen
E
E
Juvonen
E
E
Koivunen
T
T
Siitonen
T
T
Lehtinen
O
O
Kuittinen
S
S
Leppä
V-J
VJ
Anttila
M
M
Itälä
T
T
Wiklund
K
K
Remes
T
T
Nousiainen
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001228:Aspergillosis / Q000453:epidemiology / Q000209:etiology; D002177:Candidiasis / Q000453:epidemiology / Q000209:etiology; D005387:Finland / Q000453:epidemiology; D019337:Hematologic Neoplasms / Q000150:complications / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D009181:Mycoses / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology*; D011159:Population Surveillance; D011795:Surveys and Questionnaires; D019172:Transplantation Conditioning / Q000379:methods; D014182:Transplantation, Autologous