Incidence and risk factors of probable and proven invasive fungal infection in adult patients receiving allogeneic hematopoietic stem cell transplantation.
BACKGROUND
To investigate the incidence and risk factors for the occurrence of proven or probable invasive fungal infection (IFI) in adult patients receiving allogeneic hematopoietic stem cell transplantation (HSCT).


METHODS
We retrospectively analyzed 421 patients undergoing HSCT between 2002 and 2013 in our hospital. The risk factors for the occurrence of IFI were analyzed using Cox regression models.


RESULTS
Thirty-one patients with the median age of 42 years (range, 19-60 years) developed IFI after HSCT. The post-HSCT IFI incidence was 7.4% and median time from HSCT to the diagnosis of IFI was 139 days (range, 2-1809 days). Of the pretransplant factors, European Group for Blood and Marrow Transplantation (EBMT) risk score > 2 (p = 0.001) and prior history of IFI (p = 0.006) or type 2 diabetes mellitus (DM; p = 0.042) were the significant predictors for post-HSCT IFI in univariate analyses. In multivariate analysis, EBMT risk score > 2 (p = 0.015) and prior history of IFI (p = 0.006) retained significance. Of the post-transplant factors, acute graft-versus-disease (GVHD) overall Grade III-IV (p < 0.001), extensive chronic GVHD (p = 0.002), development of post-transplant lymphoproliferative disorders (p = 0.005), and the use of high-dose steroids (p < 0.001) were statistically significant in univariate analyses. After multivariate analysis, high-dose steroids (p < 0.001) and acute GVHD overall Grade III-IV (p = 0.045) retained significance.


CONCLUSIONS
These results suggest that risk group stratification prior to HSCT and monitoring of IFI in patients with severe GVHD receiving high-dose steroids is mandatory to reduce the mortality and morbidity of post-HSCT IFI, especially in those with prior history of IFI.
Department of Medicine of Yang-Ming Branch, Taipei City Hospital, Taiwan; Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
Yao-Chung
YC
Liu
Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
Sheng-Hsuan
SH
Chien
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.
Nai-Wen
NW
Fan
Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medicine, Cardinal Tien Hospital, Taipei, Taiwan.
Ming-Hung
MH
Hu
Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan. Electronic address: jpgau@vghtpe.gov.tw.
Jyh-Pyng
JP
Gau
Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
Chia-Jen
CJ
Liu
Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
Yuan-Bin
YB
Yu
Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
Chun-Yu
CY
Liu
Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
Liang-Tsai
LT
Hsiao
Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
Jin-Hwang
JH
Liu
Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
Tzeon-Jye
TJ
Chiou
Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
Po-Min
PM
Chen
Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
Cheng-Hwai
CH
Tzeng
D000328:Adult; D000368:Aged; D001228:Aspergillosis / Q000453:epidemiology* / Q000382:microbiology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D000072742:Invasive Fungal Infections / Q000453:epidemiology* / Q000382:microbiology; D008297:Male; D008775:Methylprednisolone / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult
D008775:Methylprednisolone
Allogeneic hematopoietic stem cell transplantation; Graft-versus-host disease; Invasive fungal infection