title: Predictors of invasive fungal infection in pediatric allogeneic hematopoietic SCT recipients.
abstract: This study was aimed at finding predictors of invasive fungal infection (IFI) after pediatric allogeneic hematopoietic SCT (HSCT). All children who received allogeneic HSCT in the Wilhelmina Children's Hospital Utrecht between 2004 and 2012 were included. HSCT data were prospectively collected. Patients were retrospectively classified into high- or low-risk groups for developing IFI using criteria based on available literature. Predictors for the occurrence of IFI were analyzed using Cox regression models. We used logistic regression models to analyze the association between other HSCT-related complications and IFI. Secondary outcomes were overall survival and treatment-related mortality (TRM). Two-hundred nine patients were included in the analysis; median age was 6.6 years. The cumulative incidence of IFI was 12%. In patients classified as 'low risk' (n=75), only 5.3% developed IFI (odds ratio (OR): 0.325; P=0.047). In multivariate analysis, a predictor for the occurrence of IFI was an a priori determined HSCT TRM risk >20% (based on EBMT-risk score). Post-HSCT, the administration of high-dose steroids was associated with IFI (OR: 4.458; P=0.010). Patients who developed IFI showed an increased risk of TRM (OR: 3.773; P=0.004). These results confirm that risk group stratification should guide intensity of monitoring for IFI and use of antifungal prophylaxis.
authors.affiliation: Department of Pediatric Blood and Marrow Transplantation, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands.
authors.forename: J A
authors.initials: JA
authors.lastname: Hol
authors.affiliation: Department of Pediatric Blood and Marrow Transplantation, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands.
authors.forename: T F W
authors.initials: TF
authors.lastname: Wolfs
authors.affiliation: Department of Pediatric Blood and Marrow Transplantation, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands.
authors.forename: M B
authors.initials: MB
authors.lastname: Bierings
authors.affiliation: Department of Pediatric Blood and Marrow Transplantation, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands.
authors.forename: C A
authors.initials: CA
authors.lastname: Lindemans
authors.affiliation: Department of Pediatric Blood and Marrow Transplantation, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands.
authors.forename: A B J
authors.initials: AB
authors.lastname: Versluys
authors.affiliation: Department of Pediatric Blood and Marrow Transplantation, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Wildt de
authors.affiliation: Department of Pediatric Blood and Marrow Transplantation, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands.
authors.forename: C E
authors.initials: CE
authors.lastname: Gerhardt
authors.affiliation: Department of Pediatric Blood and Marrow Transplantation, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Boelens
mesh_terms: D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications; D002177:Candidiasis / Q000150:complications; D000077336:Caspofungin; D002648:Child; D002675:Child, Preschool; D054714:Echinocandins / Q000627:therapeutic use; D005260:Female; D060585:Fusariosis / Q000150:complications; D006086:Graft vs Host Disease / Q000188:drug therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D055666:Lipopeptides; D016015:Logistic Models; D008297:Male; D009181:Mycoses / Q000150:complications* / Q000175:diagnosis*; D009504:Neutrophils / Q000166:cytology; D011446:Prospective Studies; D011743:Pyrimidines / Q000627:therapeutic use; D012189:Retrospective Studies; D012306:Risk; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D011743:Pyrimidines; D014230:Triazoles; C068538:liposomal amphotericin B; D000666:Amphotericin B; D000077336:Caspofungin; D065819:Voriconazole