Prognostic factors for death due to invasive aspergillosis after hematopoietic stem cell transplantation: a 1-year retrospective study of consecutive patients at French transplantation centers.
BACKGROUND
Invasive aspergillosis (IA) is a major cause of death after hematopoietic stem cell transplantation (HSCT). The goal of this retrospective and consecutive survey was to assess prognostic factors of death due to IA after HSCT at the time of diagnosis of IA.


METHODS
All 64 health care centers affiliated with the Société Française de Greffe de Moelle et de Thérapie Cellulaire were contacted to participate in this study of all proven or probable cases of IA that occurred among HSCT recipients in 2002. Data for 51 cases (41 involving allogeneic HSCT and 10 involving autologous HSCT) were collected from patient records and included diagnostic and therapeutic features of IA, outcome, presence of hematological disease, and transplantation data. Cox models were applied to risk factors for death attributed to IA that were initially identified using the usual tests.


RESULTS
The proportion of deaths attributed to IA within 4 months after diagnosis was 0.62 (95% confidence interval, 0.47-0.76). Seven factors assessed at diagnosis were determined to be strongly related to death due to IA: age of 12-35 years, dissemination of IA, presence of a pleural effusion, monocyte count of <120 cells/mm3, prolonged administration of steroids within the previous 2 months, receipt of a dose > or =2 mg/kg at the time of diagnosis, and uncontrolled graft-versus-host disease.Conclusions. Our study explored potential risk factors for death due to IA among HSCT recipients as a reference for investigation in larger future studies. These factors should help to identify HSCT recipients who would benefit from more-aggressive antifungal therapies.
Cordonnier
Catherine
C
Hopital Henri Mondor, AP-HP and Université Paris 12, France. carlcord@club-internet.fr
Ribaud
Patricia
P
Herbrecht
Raoul
R
Milpied
Noël
N
Valteau-Couanet
Dominique
D
Morgan
Caroline
C
Wade
Amath
A
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000401:mortality* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000009:adverse effects; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors
D000935:Antifungal Agents; D011241:Prednisone