Invasive fungal infection following reduced-intensity cord blood transplantation for adult patients with hematologic diseases.
Invasive fungal infection (IFI) is a significant complication after allogeneic hematopoietic stem cell transplantation (HSCT); however, we have little information on its clinical features after reduced intensity cord blood transplantation (RICBT) for adults. We reviewed medical records of 128 patients who underwent RICBT at Toranomon Hospital between March 2002 and November 2005. Most of the patients received purine-analogbased preparative regimens. Graft-versus-host disease (GVHD) prophylaxis was a continuous infusion of either tacrolimus 0.03 mg/kg or cyclosporine 3 mg/kg. IFI was diagnosed according to the established EORTC/NIH-MSG criteria. IFI was diagnosed in 14 patients. Thirteen of the 14 had probable invasive pulmonary aspergillosis and the other had fungemia resulting from Trichosporon spp. Median onset of IFI was day 20 (range: 1-82), and no patients developed IFI after day 100. Three-year cumulative incidence of IA was 10.2%. Four of the 13 patients with invasive aspergillosis (IA) developed grade II-IV acute GVHD, and their IA was diagnosed before the onset of acute GVHD. The mortality rate of IFI was 86%. Multivariate analysis revealed that the use of prednisolone >0.2 mg/kg (relative risk 7.97, 95% confidence interval 2.24-28.4, P = .0014) was a significant risk factor for IA. This study suggests that IFI is an important cause of deaths after RICBT, and effective strategies are warranted to prevent IFI.
Miyakoshi
Shigesaburo
S
Department of Hematology, Toranomon Hospital, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan.
Kusumi
Eiji
E
Matsumura
Tomoko
T
Hori
Akiko
A
Murashige
Naoko
N
Hamaki
Tamae
T
Yuji
Koichiro
K
Uchida
Naoyuki
N
Masuoka
Kazuhiro
K
Wake
Atsushi
A
Kanda
Yoshinobu
Y
Kami
Masahiro
M
Tanaka
Yuji
Y
Taniguchi
Shuichi
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000139:chemically induced / Q000401:mortality*; D036101:Cord Blood Stem Cell Transplantation; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D016469:Fungemia / Q000139:chemically induced / Q000401:mortality*; D006086:Graft vs Host Disease / Q000150:complications / Q000517:prevention & control; D019337:Hematologic Neoplasms / Q000150:complications / Q000401:mortality* / Q000628:therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects; D014250:Trichosporon
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone; D016559:Tacrolimus