title: Pre-existing invasive fungal infection is not a contraindication for allogeneic HSCT for patients with hematologic malignancies: a CIBMTR study.
abstract: Patients with prior invasive fungal infection (IFI) increasingly proceed to allogeneic hematopoietic cell transplantation (HSCT). However, little is known about the impact of prior IFI on survival. Patients with pre-transplant IFI (cases; n=825) were compared with controls (n=10247). A subset analysis assessed outcomes in leukemia patients pre- and post 2001. Cases were older with lower performance status (KPS), more advanced disease, higher likelihood of AML and having received cord blood, reduced intensity conditioning, mold-active fungal prophylaxis and more recently transplanted. Aspergillus spp. and Candida spp. were the most commonly identified pathogens. 68% of patients had primarily pulmonary involvement. Univariate and multivariable analysis demonstrated inferior PFS and overall survival (OS) for cases. At 2 years, cases had higher mortality and shorter PFS with significant increases in non-relapse mortality (NRM) but no difference in relapse. One year probability of post-HSCT IFI was 24% (cases) and 17% (control, P<0.001). The predominant cause of death was underlying malignancy; infectious death was higher in cases (13% vs 9%). In the subset analysis, patients transplanted before 2001 had increased NRM with inferior OS and PFS compared with later cases. Pre-transplant IFI is associated with lower PFS and OS after allogeneic HSCT but significant survivorship was observed. Consequently, pre-transplant IFI should not be a contraindication to allogeneic HSCT in otherwise suitable candidates. Documented pre-transplant IFI is associated with lower PFS and OS after allogeneic HSCT. However, mortality post transplant is more influenced by advanced disease status than previous IFI. Pre-transplant IFI does not appear to be a contraindication to allogeneic HSCT.
authors.affiliation: Adult Blood and Marrow Stem Cell Transplant Program, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA.
authors.forename: R T
authors.initials: RT
authors.lastname: Maziarz
authors.affiliation: CIBMTR, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.|Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: R
authors.initials: R
authors.lastname: Brazauskas
authors.affiliation: CIBMTR, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: M
authors.initials: M
authors.lastname: Chen
authors.affiliation: Adult Blood and Marrow Stem Cell Transplant Program, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: McLeod
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: Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Wingard
authors.affiliation: Department of Oncology, King Faisal Specialist Hospital Center & Research, Riyadh, Saudi Arabia.
authors.forename: M
authors.initials: M
authors.lastname: Aljurf
authors.affiliation: Hematology Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA.
authors.forename: M
authors.initials: M
authors.lastname: Battiwalla
authors.affiliation: Department of Pediatrics, University of California San Francisco Medical Center, San Francisco, CA, USA.
authors.forename: C C
authors.initials: CC
authors.lastname: Dvorak
authors.affiliation: Department of Hematology, Christian Medical College, Vellore, India.
authors.forename: B
authors.initials: B
authors.lastname: Geroge
authors.affiliation: Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
authors.forename: E C
authors.initials: EC
authors.lastname: Guinan
authors.affiliation: Department of Hematology/Oncology, All Children's Hospital, St Petersburg, FL, USA.
authors.forename: G A
authors.initials: GA
authors.lastname: Hale
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: BMT Center, Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, South Korea.
authors.forename: J-W
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Liesveld
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Ramanathan
authors.affiliation: Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL, USA.
authors.forename: V
authors.initials: V
authors.lastname: Reddy
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: B N
authors.initials: BN
authors.lastname: Savani
authors.affiliation: University of Cincinnati Cancer Institute, Cincinnati, OH, USA.
authors.forename: F O
authors.initials: FO
authors.lastname: Smith
authors.affiliation: Infectious Disease Clinic, Oregon Health and Science University, Portland, OR, USA.
authors.forename: L
authors.initials: L
authors.lastname: Strasfeld
authors.affiliation: Infectious Diseases Program, UC San Diego Health, La Jolla, CA, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Taplitz
authors.affiliation: Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical Center, Minneapolis, MN, USA.
authors.forename: C
authors.initials: C
authors.lastname: Ustun
authors.affiliation: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Boeckh
authors.affiliation: Experimental Transplantation and Immunology Branch, National Institutes of Health-National Cancer Institute, Bethesda, MD, USA.
authors.forename: J
authors.initials: J
authors.lastname: Gea-Banacloche
authors.affiliation: Pediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: C A
authors.initials: CA
authors.lastname: Lindemans
authors.affiliation: Divisions of Hematology/Oncology, Bone Marrow Transplantation and Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Auletta
authors.affiliation: Division of Hematology/Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Riches
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D001228:Aspergillosis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D001230:Aspergillus; D002175:Candida; D002177:Candidiasis / Q000209:etiology / Q000401:mortality / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation; D018572:Disease-Free Survival; D005260:Female; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012042:Registries; D015996:Survival Rate