title: Risk Factors and Outcomes of Invasive Fungal Infections in Allogeneic Hematopoietic Cell Transplant Recipients.
abstract: Allogeneic hematopoietic cell transplant (HCT) recipients are at increased risk of invasive fungal infections (IFI), which are associated with a high mortality rate. We evaluated the impact of IFI in allogeneic HCT patients. In total, 541 consecutive allogeneic HCT recipients were included. The cumulative incidence of any IFI and mold infections at 1-year post-HCT was 10 and 7%, respectively. Median times to IFI and mold infection were 200 and 210 days, respectively. There was a trend toward fewer IFI and mold infections in the last several years. Both acute graft-versus-host disease (GVHD) (OR 1.83, p = 0.05) and corticosteroid duration (OR 1.0, p = 0.026) were significantly associated with increased risk of IFI, acute GVHD (OR 2.3, p = 0.027) emerged as the most important association with mold infections. Any IFI [HR 4.1 (2.79-6.07), p < 0.0001] and mold infections [HR 3.34 (2.1-5.1), p < 0.0001] were independently associated with non-relapse mortality (NRM). This association persisted in the setting of both acute and chronic GVHD. Corticosteroid treatment for >90 days was also significantly associated with higher NRM [HR 1.9 (1.3-2.6), p < 0.0001]. This study highlights the impact of IFI on NRM among HCT patients. The decrease in number of IFI and mold infections over the last several years may reflect the benefit of prophylaxis with mold-active antifungal agents.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, 3119 Taubman Center, Ann Arbor, MI, 48109, USA. mmiceli@med.umich.edu.
authors.forename: Marisa H
authors.identifier: http://orcid.org/0000-0002-3175-0512
authors.initials: MH
authors.lastname: Miceli
authors.affiliation: Adult Blood and Marrow Transplantation Program, Ann Arbor, MI, USA.
authors.forename: Tracey
authors.initials: T
authors.lastname: Churay
authors.affiliation: Department of Biostatistics, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Braun
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Health System, 3119 Taubman Center, Ann Arbor, MI, 48109, USA.|Division of Infectious Diseases, Department of Internal Medicine, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.
authors.forename: Carol A
authors.initials: CA
authors.lastname: Kauffman
authors.affiliation: Huntsman Cancer Center, University of Utah, Salt Lake City, UT, USA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Couriel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D000072742:Invasive Fungal Infections / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D066027:Transplant Recipients; D014184:Transplantation, Homologous / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Aspergillosis; Candidiasis; Hematopoietic cell transplantation; Invasive fungal infections; Mold infections