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.
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.
Martino
Rodrigo
R
Hematology Department of Sant Pau Hospital, Autonomous University of Barcelona, Spain. rmartino@santpau.es
Parody
Rocio
R
Fukuda
Takahiro
T
Maertens
Johan
J
Theunissen
Koen
K
Ho
Aloysius
A
Mufti
Ghulam J
GJ
Kroger
Nicolaus
N
Zander
Arnold R
AR
Heim
Dominik
D
Paluszewska
Monika
M
Selleslag
Dominik
D
Steinerova
Katerina
K
Ljungman
Per
P
Cesaro
Simone
S
Nihtinen
Anna
A
Cordonnier
Catherine
C
Vazquez
Lourdes
L
López-Duarte
Monica
M
Lopez
Javier
J
Cabrera
Rafael
R
Rovira
Montserrat
M
Neuburger
Stefan
S
Cornely
Oliver
O
Hunter
Ann E
AE
Marr
Kieren A
KA
Dornbusch
Hans Jürgen
HJ
Einsele
Hermann
H
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*