title: Delphi-based study and analysis of key risk factors for invasive fungal infection in haematological patients.
abstract: OBJECTIVE
  Mortality caused by invasive fungal infections due to filamentous fungi (IFI-FF) is high. Predisposing factors to IFI-FF are multiple and should be stratified. The objective of this study was to identify key risk factors for IFI-FF in onco-haematological patients in different clinical settings.
  
  
  METHODS
  Prospective national Delphi study. Risk factors for IFI-FF in patients with onco-haematological diseases were identified by a systematic review of the literature. An anonymous survey was sent by e-mail to a panel of experts. A key risk factor was defined when at least 70% of the surveyed participants assigned a "maximal" or "high" risk.
  
  
  RESULTS
  In allogenic stem cell transplantation, 18 of the 42 risk factors analyzed were classified as key risk factors, including neutropenia, previous IFI-FF, grade III/IV acute or extensive chronic graft-versus-host disease (GVHD), umbilical cord blood transplantation, HLA mismatching transplantation, graft failure, absence of HEPA filters, absence of laminar air flow, diagnosis of acute myeloid leukaemia, haploidentical transplantation, anti-TNF-α drugs, alemtuzumab, anti-thymocyte globulin, immunosuppressive prophylaxis for GVHD, lymphocytopenia, cytomegalovirus infection, and proximity to construction areas. In acute leukaemia/myelodysplastic syndrome (AL/MDS), 7 of 25 risk factors were defined as key risk factors, including neutropenia, consolidation therapy without response, induction therapy, antifungal prophylaxis with azoles, proximity to construction areas, and absence of HEPA filters. In lymphoma/multiple myeloma (MM), the five key risk factors among 21 analyzed were use of steroids, neutropenia, progressive disease, anti-CD52 therapies, and proximity to construction areas.
  
  
  CONCLUSIONS
  The Delphi method was useful for the classification and stratification of risk factors for IFI-FF in patients with onco-haematological diseases. Identifying key risk factors will contribute to a better management of IFI-FF in this group of patients at high or changing risk.
authors.forename: L
authors.initials: L
authors.lastname: Vázquez
authors.affiliation: Miguel Salavert, Unit of Infectious Diseases, Hospital Universitario y Politécnico La Fe Av. Fernando Abril Martorell 106, E-46026 Valencia, Spain. salavert_mig@gva.es.
authors.forename: M
authors.initials: M
authors.lastname: Salavert
authors.forename: J
authors.initials: J
authors.lastname: Gayoso
authors.forename: M
authors.initials: M
authors.lastname: Lizasoaín
authors.forename: I
authors.initials: I
authors.lastname: Ruiz Camps
authors.forename: N
authors.initials: N
authors.lastname: Di Benedetto
mesh_terms: D036101:Cord Blood Stem Cell Transplantation; D003697:Delphi Technique; D005658:Fungi; D006084:Graft Rejection / Q000150:complications; D006086:Graft vs Host Disease / Q000150:complications / Q000453:epidemiology; D006402:Hematologic Diseases / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D019337:Hematologic Neoplasms / Q000150:complications; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D000072742:Invasive Fungal Infections / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D009503:Neutropenia / Q000453:epidemiology; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors