title: Risk factors for recurrence of invasive fungal infection during secondary antifungal prophylaxis in allogeneic hematopoietic stem cell transplant recipients.
abstract: BACKGROUND
  Invasive fungal infections (IFIs) are a major cause of mortality among allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients. Thanks to the widespread use of secondary antifungal prophylaxis (SAP), a history of IFI is not an absolute contraindication to allo-HSCT. However, IFI recurrence remains a risk factor for transplant-related mortality.
  
  
  METHODS
  To evaluate the risk factors for IFI recurrence in allo-HSCT patients receiving SAP, we performed a retrospective analysis of 90 individuals treated at our hospital. SAP antifungal agents included fluconazole (n = 28), voriconazole (n = 25), itraconazole (n = 23), caspofungin (n = 7), and micafungin (n = 7).
  
  
  RESULTS
  By day +100, recurrent IFI had occurred in 23 (25.5%) patients. Our multivariate analysis identified 4 factors significantly associated with a risk of IFI recurrence within 100 days of allo-HSCT: duration of neutropenia >18 days, presence of severe acute graft-versus-host disease (aGVHD), <70-day interval between previous infection and transplantation, and use of a narrow-spectrum SAP agent (P = 0.008, 0.010, 0.041, and 0.001, respectively). Of the 87 patients who remained in the study for the duration of the follow-up period (median length: 551 days), 26 (29.9%) died; only 7 (8.0%) of these deaths resulted from a severe fungal infection.
  
  
  CONCLUSIONS
  These results suggest that transplantation outcome can be improved by adequate antifungal treatment before transplantation, better prevention of, and therapy for, severe aGVHD, use of granulocyte colony-stimulating factor to reduce the duration of neutropenia, and use of broad-spectrum prophylaxis agents.
authors.affiliation: Hematology, West China Hospital, Sichuan University, Chengdu, Sichuan, China. lfyh2006@yahoo.com
authors.forename: F
authors.initials: F
authors.lastname: Liu
authors.forename: T
authors.initials: T
authors.lastname: Wu
authors.forename: J B
authors.initials: JB
authors.lastname: Wang
authors.forename: X Y
authors.initials: XY
authors.lastname: Cao
authors.forename: Y M
authors.initials: YM
authors.lastname: Yin
authors.forename: Y L
authors.initials: YL
authors.lastname: Zhao
authors.forename: D P
authors.initials: DP
authors.lastname: Lu
mesh_terms: D019072:Antibiotic Prophylaxis; D000935:Antifungal Agents / Q000627:therapeutic use*; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications / Q000188:drug therapy; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D009181:Mycoses / Q000188:drug therapy / Q000517:prevention & control; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D014184:Transplantation, Homologous / Q000009:adverse effects
chemical_list: D000935:Antifungal Agents; D016179:Granulocyte Colony-Stimulating Factor