Incidence and risk factors of probable and proven invasive fungal infection in adult patients receiving allogeneic hematopoietic stem cell transplantation

Yao Chung Liu, Sheng Hsuan Chien, Nai Wen Fan, Ming Hung Hu, Jyh Pyng Gau, Chia Jen Liu, Yuan Bin Yu, Chun Yu Liu, Liang Tsai Hsiao, Jin Hwang Liu, Tzeon Jye Chiou, Po Min Chen, Cheng Hwai Tzeng

Research output: Contribution to journalArticlepeer-review

24 Citations (Scopus)

Abstract

Background To investigate the incidence and risk factors for the occurrence of proven or probable invasive fungal infection (IFI) in adult patients receiving allogeneic hematopoietic stem cell transplantation (HSCT). Methods We retrospectively analyzed 421 patients undergoing HSCT between 2002 and 2013 in our hospital. The risk factors for the occurrence of IFI were analyzed using Cox regression models. Results Thirty-one patients with the median age of 42 years (range, 19–60 years) developed IFI after HSCT. The post-HSCT IFI incidence was 7.4% and median time from HSCT to the diagnosis of IFI was 139 days (range, 2–1809 days). Of the pretransplant factors, European Group for Blood and Marrow Transplantation (EBMT) risk score > 2 (p = 0.001) and prior history of IFI (p = 0.006) or type 2 diabetes mellitus (DM; p = 0.042) were the significant predictors for post-HSCT IFI in univariate analyses. In multivariate analysis, EBMT risk score > 2 (p = 0.015) and prior history of IFI (p = 0.006) retained significance. Of the post-transplant factors, acute graft-versus-disease (GVHD) overall Grade III–IV (p < 0.001), extensive chronic GVHD (p = 0.002), development of post-transplant lymphoproliferative disorders (p = 0.005), and the use of high-dose steroids (p < 0.001) were statistically significant in univariate analyses. After multivariate analysis, high-dose steroids (p < 0.001) and acute GVHD overall Grade III–IV (p = 0.045) retained significance. Conclusion These results suggest that risk group stratification prior to HSCT and monitoring of IFI in patients with severe GVHD receiving high-dose steroids is mandatory to reduce the mortality and morbidity of post-HSCT IFI, especially in those with prior history of IFI.

Original languageEnglish
Pages (from-to)567-574
Number of pages8
JournalJournal of Microbiology, Immunology and Infection
Volume49
Issue number4
DOIs
Publication statusPublished - Aug 1 2016
Externally publishedYes

Keywords

  • Allogeneic hematopoietic stem cell transplantation
  • Graft-versus-host disease
  • Invasive fungal infection

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology and Microbiology(all)
  • Microbiology (medical)
  • Infectious Diseases

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