title: Risk factors and impact of non-Aspergillus mold infections following allogeneic HCT: a CIBMTR infection and immune reconstitution analysis.
abstract: Risk factors for non-Aspergillus mold infection (NAMI) and the impact on transplant outcome are poorly assessed in the current era of antifungal agents. Outcomes of 124 patients receiving allogeneic hematopoietic cell transplantation (HCT) diagnosed with either mucormycosis (n=72) or fusariosis (n=52) between days 0 and 365 after HCT are described and compared with a control cohort (n=11 856). Patients with NAMI had more advanced disease (mucormycois: 25%, fusariosis: 23% and controls: 18%; P=0.004) and were more likely to have a Karnofsky performance status (KPS) <90% at HCT (mucormycosis: 42%, fusariosis: 38% and controls: 28%; P=0.048). The 1-year survival after HCT was 22% (15-29%) for cases and was significantly inferior compared with controls (65% (64-65%); P<0.001). Survival from infection was similarly dismal regardless of mucormycosis: 15% (8-25%) and fusariosis: 21% (11-33%). In multivariable analysis, NAMI was associated with a sixfold higher risk of death (P<0.0001) regardless of the site or timing of infection. Risk factors for mucormycosis include preceding acute GvHD, prior Aspergillus infection and older age. For fusariosis, increased risks including receipt of cord blood, prior CMV infection and transplant before May 2002. In conclusion, NAMI occurs infrequently, is associated with high mortality and appears with similar frequency in the current antifungal era.
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Riches
authors.affiliation: Pharmacy Department, Northwestern Memorial Hospital, Chicago, IL, USA.
authors.forename: S
authors.initials: S
authors.lastname: Trifilio
authors.affiliation: Department of Medicine, Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: M
authors.initials: M
authors.lastname: Chen
authors.affiliation: Department of Medicine, Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI, USA.|Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: K W
authors.initials: KW
authors.lastname: Ahn
authors.affiliation: Department of Hematology and Medical Oncology, Emory University Hospital, Atlanta, GA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Langston
authors.affiliation: Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: H M
authors.initials: HM
authors.lastname: Lazarus
authors.affiliation: Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, UK.
authors.forename: D I
authors.initials: DI
authors.lastname: Marks
authors.affiliation: Division of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Martino
authors.affiliation: Center for Hematologic Malignancies, Oregon Health and Science University, Portland, OR, USA.
authors.forename: R T
authors.initials: RT
authors.lastname: Maziarz
authors.affiliation: Infectious Diseases Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: G A
authors.initials: GA
authors.lastname: Papanicolou
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Wingard
authors.affiliation: Division of Infectious Disease and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: J-A H
authors.initials: JA
authors.lastname: Young
authors.affiliation: Department of Medication Safety and Efficacy, University of South Carolina, Columbia, SC, USA.
authors.forename: C L
authors.initials: CL
authors.lastname: Bennett
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D064591:Allografts; D001230:Aspergillus; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D060585:Fusariosis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D015996:Survival Rate