title: Lower respiratory tract respiratory virus infections increase the risk of invasive aspergillosis after a reduced-intensity allogeneic hematopoietic SCT.
abstract: We have analyzed the incidence and risk factors for the occurrence of invasive aspergillosis (IA) among 219 consecutive recipients of an allogeneic hematopoietic SCT after a reduced-intensity conditioning regimen (Allo-RIC). Twenty-seven patients developed an IA at a median of 218 days (range 24-2051) post-Allo-RIC, for a 4-year incidence of 13% (95% confidence interval 4-24%). In multivariate analysis, risk factors for developing IA were steroid therapy for moderate-to-severe graft vs host disease (GVHD) (Hazard Ratio (HR) 2.9, P=0.03), occurrence of a lower respiratory tract infection (LRTI) by a respiratory virus (RV) (HR 4.3, P<0.01) and CMV disease (HR 2.8, P=0.03). Variables that decreased survival after Allo-RIC were advanced disease phase (HR 1.9, P=0.02), steroid therapy for moderate-to-severe GVHD (HR 2.2, P<0.01), not developing chronic GVHD (HR 4.3, P<0.01), occurrence of LRTI by an RV (HR 3.4, P<0.01) and CMV disease (HR 2, P=0.01), whereas occurrence of IA had no effect on survival (P=0.5). Our results show that IA is a common infectious complication after an Allo-RIC, which occurs late post-transplant and may not have a strong effect on survival. An important observation is the possible role of LRTI by conventional RVs as risk factors for IA.
authors.affiliation: Division of Clinical Hematology, Hospital de la Sant Creu i Sant Pau, Autonomous University of Barcelona, Sant Antoni Maria Claret 167, Barcelona, Catalunya, Spain. rmartino@santpau.cat
authors.forename: R
authors.initials: R
authors.lastname: Martino
authors.forename: J L
authors.initials: JL
authors.lastname: Piñana
authors.forename: R
authors.initials: R
authors.lastname: Parody
authors.forename: D
authors.initials: D
authors.lastname: Valcarcel
authors.forename: A
authors.initials: A
authors.lastname: Sureda
authors.forename: S
authors.initials: S
authors.lastname: Brunet
authors.forename: J
authors.initials: J
authors.lastname: Briones
authors.forename: J
authors.initials: J
authors.lastname: Delgado
authors.forename: F
authors.initials: F
authors.lastname: Sánchez
authors.forename: N
authors.initials: N
authors.lastname: Rabella
authors.forename: J
authors.initials: J
authors.lastname: Sierra
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000209:etiology* / Q000276:immunology / Q000517:prevention & control / Q000821:virology; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000276:immunology / Q000382:microbiology* / Q000821:virology; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D014184:Transplantation, Homologous; D014777:Virus Diseases / Q000209:etiology / Q000276:immunology / Q000382:microbiology*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents