title: Impact of the intensity of the pretransplantation conditioning regimen in patients with prior invasive aspergillosis undergoing allogeneic hematopoietic stem cell transplantation: A retrospective survey of the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation.
abstract: In this retrospective study, we analyzed the outcomes of 129 patients who underwent an allogeneic hematopoietic stem cell transplantation (allo-HSCT) and had a history of probable or proven invasive aspergillosis (IA), of whom 57 (44%) received a reduced-intensity conditioning (RIC). Overall, 27 patients with IA progressed after the allo-HSCT (cumulative incidence [CumInc] at 2 years, 22%). The variables that increased the 2-year CumInc of IA progression were (1) longer duration of neutropenia after transplantation; (2) advanced status of the underlying disease; and (3) less than 6 weeks from start of systemic anti-Aspergillus therapy and the allo-HSCT. In addition, (4) conventional myeloablative conditioning increased the risk of progression early after transplantation (before day 30) only, while 3 variables increased the risk beyond day 30 were (5) cytomegalovirus disease; (6) bone marrow or cord blood as source of stem cells; and (7) grades II to IV acute graft-versus-host disease (GVHD). A risk model for progression was generated, defined as low (0-1 risk factors, 6% incidence), intermediate (2-3 risk factors, 27% incidence), or high risk (> or = 3 risk factors, 72% incidence [P < .001]). These findings may help in the interpretation and design of future studies on secondary prophylaxis of IA after an allo-HSCT.
authors.affiliation: Hematology Department of Sant Pau Hospital, Autonomous University of Barcelona, Spain. rmartino@santpau.es
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Martino
authors.forename: Rocio
authors.initials: R
authors.lastname: Parody
authors.forename: Takahiro
authors.initials: T
authors.lastname: Fukuda
authors.forename: Johan
authors.initials: J
authors.lastname: Maertens
authors.forename: Koen
authors.initials: K
authors.lastname: Theunissen
authors.forename: Aloysius
authors.initials: A
authors.lastname: Ho
authors.forename: Ghulam J
authors.initials: GJ
authors.lastname: Mufti
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Kroger
authors.forename: Arnold R
authors.initials: AR
authors.lastname: Zander
authors.forename: Dominik
authors.initials: D
authors.lastname: Heim
authors.forename: Monika
authors.initials: M
authors.lastname: Paluszewska
authors.forename: Dominik
authors.initials: D
authors.lastname: Selleslag
authors.forename: Katerina
authors.initials: K
authors.lastname: Steinerova
authors.forename: Per
authors.initials: P
authors.lastname: Ljungman
authors.forename: Simone
authors.initials: S
authors.lastname: Cesaro
authors.forename: Anna
authors.initials: A
authors.lastname: Nihtinen
authors.forename: Catherine
authors.initials: C
authors.lastname: Cordonnier
authors.forename: Lourdes
authors.initials: L
authors.lastname: Vazquez
authors.forename: Monica
authors.initials: M
authors.lastname: López-Duarte
authors.forename: Javier
authors.initials: J
authors.lastname: Lopez
authors.forename: Rafael
authors.initials: R
authors.lastname: Cabrera
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rovira
authors.forename: Stefan
authors.initials: S
authors.lastname: Neuburger
authors.forename: Oliver
authors.initials: O
authors.lastname: Cornely
authors.forename: Ann E
authors.initials: AE
authors.lastname: Hunter
authors.forename: Kieren A
authors.initials: KA
authors.lastname: Marr
authors.forename: Hans Jürgen
authors.initials: HJ
authors.lastname: Dornbusch
authors.forename: Hermann
authors.initials: H
authors.lastname: Einsele
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000150:complications* / Q000453:epidemiology; D016026:Bone Marrow Transplantation; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D005060:Europe; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019172:Transplantation Conditioning / Q000379:methods*