Incidence and risk factors of post-engraftment invasive fungal disease in adult allogeneic hematopoietic stem cell transplant recipients receiving oral azoles prophylaxis.
Studies that analyze the epidemiology and risk factors for invasive fungal disease (IFD) after engraftment in alloSCT are few in number. This single-center retrospective study included 404 alloSCT adult recipients surviving >40 days who engrafted and were discharged without prior IFD. All patients who received ⩾20 mg/day of prednisone were assigned to primary oral prophylaxis (itraconazole or low-dose voriconazole). The primary end point was the cumulative incidence (CI) of probable/proven IFD using the European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC/MSG) criteria. The independent prognostic factors after multivariate analyses were used to construct a post-engraftment IFD risk score. The 1-year CI of IFD was 11%. The non-relapse mortality was 40% in those developing IFD and 16% in those who did not. The intent-to-treat analysis showed that 17% of patients abandoned the assigned prophylaxis. Age >40 years, ⩾1 previous SCT, pre-engraftment neutropenia >15 days, extensive chronic GVHD and CMV reactivation were independent risk factors. The post-engraftment IFD score stratified patients into low risk (0-1 factor, CI 0.7%), intermediate risk (2 factors, CI 9.9%) and high risk (3-5 factors, CI 24.7%) (P<0.0001). The antifungal prophylaxis strategy failed to prevent post-engraftment IFD in 11% of alloSCT. Our risk score could be useful to implement risk-adapted strategies using antifungal prophylaxis after engraftment.
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.
P
P
Montesinos
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.
R
R
Rodríguez-Veiga
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.
B
B
Boluda
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.
D
D
Martínez-Cuadrón
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.
I
I
Cano
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.
A
A
Lancharro
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.
J
J
Sanz
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.
M J
MJ
Arilla
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.
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F
López-Chuliá
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.
I
I
Navarro
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.
I
I
Lorenzo
Department of Infectious Diseases, Hospital Universitari i Politècnic La Fe, València, Spain.
M
M
Salavert
Department of Microbiology, Hospital Universitari i Politècnic La Fe, València, Spain.
J
J
Pemán
Department of Radiology, Hospital Universitari i Politècnic La Fe, València, Spain.
P
P
Calvillo
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.
J
J
Martínez
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.
N
N
Carpio
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.
I
I
Jarque
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.
G F
GF
Sanz
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.|Departament de Medicina, Universitat de València, Valencia, Spain.
M A
MA
Sanz
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D064591:Allografts; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D000077336:Caspofungin; D002423:Cause of Death; D004359:Drug Therapy, Combination; D054714:Echinocandins / Q000627:therapeutic use; D005260:Female; D016469:Fungemia / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D019337:Hematologic Neoplasms / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D055666:Lipopeptides; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D009503:Neutropenia / Q000517:prevention & control; D010349:Patient Compliance; D011292:Premedication; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000009:adverse effects; D017211:Treatment Failure; D014230:Triazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D055815:Young Adult
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D014230:Triazoles; C068538:liposomal amphotericin B; D016179:Granulocyte Colony-Stimulating Factor; D000666:Amphotericin B; D000077336:Caspofungin