title: Incidence and outcome of invasive fungal diseases after allogeneic stem cell transplantation: a prospective study of the Gruppo Italiano Trapianto Midollo Osseo (GITMO).
abstract: Epidemiologic investigation of invasive fungal diseases (IFDs) in allogeneic hematopoietic stem cell transplantation (allo-HSCT) may be useful to identify subpopulations who might benefit from targeted treatment strategies. The Gruppo Italiano Trapianto Midollo Osseo (GITMO) prospectively registered data on 1858 consecutive patients undergoing allo-HSCT between 2008 and 2010. Logistic regression analysis was performed to identify risk factors for proven/probable IFD (PP-IFD) during the early (days 0 to 40), late (days 41 to 100), and very late (days 101 to 365) phases after allo-HSCT and to evaluate the impact of PP-IFDs on 1-year overall survival. The cumulative incidence of PP-IFDs was 5.1% at 40 days, 6.7% at 100 days, and 8.8% at 12 months post-transplantation. Multivariate analysis identified the following variables as associated with PP-IFDs: transplant from an unrelated volunteer donor or cord blood, active acute leukemia at the time of transplantation, and an IFD before transplantation in the early phase; transplant from an unrelated volunteer donor or cord blood and grade II-IV acute graft-versus-host disease (GVHD) in the late phase; and grade II-IV acute GVHD and extensive chronic GVHD in the very late phase. The risk for PP-IFD was significantly higher when acute GVHD was followed by chronic GVHD and when acute GVHD occurred in patients undergoing transplantation with grafts from other than matched related donors. The presence of PP-IFD was an independent factor in long-term survival (hazard ratio, 2.90; 95% confidence interval, 2.32 to 3.62; P < .0001). Our findings indicate that tailored prevention strategies may be useful in subpopulations at differing levels of risk for PP-IFDs.
authors.affiliation: Department of Hematology, Azienda Policlinico Umberto I, Sapienza University of Rome, Rome, Italy. Electronic address: girmenia@bce.uniroma1.it.
authors.forename: Corrado
authors.initials: C
authors.lastname: Girmenia
authors.affiliation: Division of Hematology II, IRCCS, San Martino University Hospital - IST, Genoa, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Raiola
authors.affiliation: GIMEMA Foundation, Rome, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Piciocchi
authors.affiliation: Division of Hematology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Algarotti
authors.affiliation: Institute of Hematology and Medical Oncology, L. e A Seragnoli, Policlinico S. Orsola Malpigli, Bologna, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Stanzani
authors.affiliation: Stem Cell Transplant Unit, Fondazione Policlinico Tor Vergata, Tor Vergata University, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Cudillo
authors.affiliation: Department of Oncology and Hematology, A.O. Citta' della Salute e della Scienza di Torino, P.O. Molinette, Turin, Italy.
authors.forename: Clara
authors.initials: C
authors.lastname: Pecoraro
authors.affiliation: Department of Hematology, Azienda Ospedaliera di Careggi, Florence, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Guidi
authors.affiliation: Department of Hematology, Azienda Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.
authors.forename: Anna Paola
authors.initials: AP
authors.lastname: Iori
authors.affiliation: Unit of Hematology and Stem Cell Transplant, Az. Osp. S. Camillo-Forlanini, Rome, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Montante
authors.affiliation: Institute of Hematology, Policlinic A. Gemelli, Sacred Heath Catholic University, Rome, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Chiusolo
authors.affiliation: Division of Infectious Diseases and Bone Marrow Transplant Unit, Giannina Gaslini Institute, Genoa, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Lanino
authors.affiliation: Stem Cell Transplant Center, Division of Hematology, Ospedale IRCCS Casa Sollievo della Sofferenza, S. Giovanni Rotondo, Italy.
authors.forename: Angelo Michele
authors.initials: AM
authors.lastname: Carella
authors.affiliation: Division of Hematology, A.O. Ospedale Niguarda Cà-Granda, Milan, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Zucchetti
authors.affiliation: Chair of Hematology, Osp. S. Giovanni Battista, University of Turin, Turin, Italy.
authors.forename: Benedetto
authors.initials: B
authors.lastname: Bruno
authors.affiliation: Division of Hematology, Centro Unico Regionale TMO e Terapie Emato-Oncologiche Sovramassimali "A. Neri" Ospedale Bianchi-Melacrino-Morelli, Reggio Calabria, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Irrera
authors.affiliation: Clinic of Hematology, Azienda Ospedaliera-Universitaria, P.le S. Maria della Misericordia, Udine, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Patriarca
authors.affiliation: Transplant Center "Wilma Deplano," Ospedale oncologico Armando Businco, Cagliari, Italy.
authors.forename: Donatella
authors.initials: D
authors.lastname: Baronciani
authors.affiliation: Unit of Onco-hematology and Stem Cell Transplant, Dip. Oncologico La Maddalena, Palermo, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Musso
authors.affiliation: Oncology, Hematology and Hematopoietic Stem Cell Transplant Program, U.O. Pediatrics-Prof. Pession, S. Orsola-Malpighi, University of Bologna, Bologna, Italy.
authors.forename: Arcangelo
authors.initials: A
authors.lastname: Prete
authors.affiliation: Hematology, Department of Medicine and Surgery, University of Naples Federico II, Naples, Italy.
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Risitano
authors.affiliation: Chair of Hematology, Bone Marrow Transplant Unit for Adults, University of Brescia, Azienda Spedali Civili, Brescia, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Russo
authors.affiliation: Division of Hematology, Azienda Ospedaliera S.Croce e Carle, Cuneo, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Mordini
authors.affiliation: Hematology Section, Department of Emergency and Organ Transplant, University of Bari, Bari, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Pastore
authors.affiliation: Hematology, Bone Marrow Transplant Center, P.O. " R. Binaghi", Cagliari, Italy.
authors.forename: Adriana
authors.initials: A
authors.lastname: Vacca
authors.affiliation: Bone Marrow Transplant Center, Ospedale Maggiore IRCCS, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Onida
authors.affiliation: Hematology Unit, Ospedale C e G Mazzoni, Ascoli Piceno, Italy.
authors.forename: Sadia
authors.initials: S
authors.lastname: Falcioni
authors.affiliation: Division of Hematology with Bone Marrow Transplant Unit, Ospedale S.G. Moscati, Taranto, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pisapia
authors.affiliation: Chair of Hematology, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Milone
authors.affiliation: First Medical Division of Onco-hematology, Ospedale Civile di Piacenza, Piacenza, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Vallisa
authors.affiliation: Hematology Unit, Ospedale S. Carlo, Potenza, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Olivieri
authors.affiliation: Hematology Unit, IRCCS-Azienda Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Bonini
authors.affiliation: Division of Infectious Diseases and Bone Marrow Transplant Unit, Giannina Gaslini Institute, Genoa, Italy.
authors.forename: Elio
authors.initials: E
authors.lastname: Castagnola
authors.affiliation: Institute of Hematology, Policlinic A. Gemelli, Sacred Heath Catholic University, Rome, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Sica
authors.affiliation: Unit of Hematology and Stem Cell Transplant, Az. Osp. S. Camillo-Forlanini, Rome, Italy.
authors.forename: Ignazio
authors.initials: I
authors.lastname: Majolino
authors.affiliation: Department of Hematology, Azienda Ospedaliera di Careggi, Florence, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Bosi
authors.affiliation: Department of Oncology and Hematology, A.O. Citta' della Salute e della Scienza di Torino, P.O. Molinette, Turin, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Busca
authors.affiliation: Stem Cell Transplant Unit, Fondazione Policlinico Tor Vergata, Tor Vergata University, Rome, Italy.
authors.forename: William
authors.initials: W
authors.lastname: Arcese
authors.affiliation: Institute of Hematology and Medical Oncology, L. e A Seragnoli, Policlinico S. Orsola Malpigli, Bologna, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bandini
authors.affiliation: Division of Hematology II, IRCCS, San Martino University Hospital - IST, Genoa, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacigalupo
authors.affiliation: Division of Hematology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rambaldi
authors.affiliation: Pediatrics and Pediatric Hematology Unit, Az. Osp. S.Camillo-Forlanini, Rome, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Locasciulli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology* / Q000209:etiology; D011446:Prospective Studies; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: Allogeneic HSCT; Epidemiology; Invasive fungal disease