Incidence and risk factors of post-engraftment invasive fungal disease in adult allogeneic hematopoietic stem cell transplant recipients receiving oral azoles prophylaxis.

Abstract

Studies that analyze the epidemiology and risk factors for invasive fungal disease (IFD) after engraftment in alloSCT are few in number. This single-center retrospective study included 404 alloSCT adult recipients surviving >40 days who engrafted and were discharged without prior IFD. All patients who received ⩾20 mg/day of prednisone were assigned to primary oral prophylaxis (itraconazole or low-dose voriconazole). The primary end point was the cumulative incidence (CI) of probable/proven IFD using the European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC/MSG) criteria. The independent prognostic factors after multivariate analyses were used to construct a post-engraftment IFD risk score. The 1-year CI of IFD was 11%. The non-relapse mortality was 40% in those developing IFD and 16% in those who did not. The intent-to-treat analysis showed that 17% of patients abandoned the assigned prophylaxis. Age >40 years, ⩾1 previous SCT, pre-engraftment neutropenia >15 days, extensive chronic GVHD and CMV reactivation were independent risk factors. The post-engraftment IFD score stratified patients into low risk (0-1 factor, CI 0.7%), intermediate risk (2 factors, CI 9.9%) and high risk (3-5 factors, CI 24.7%) (P<0.0001). The antifungal prophylaxis strategy failed to prevent post-engraftment IFD in 11% of alloSCT. Our risk score could be useful to implement risk-adapted strategies using antifungal prophylaxis after engraftment.

• Authors: P Montesinos, R Rodríguez-Veiga, B Boluda, D Martínez-Cuadrón, I Cano, A Lancharro, J Sanz, M J Arilla, F López-Chuliá, I Navarro, I Lorenzo, M Salavert, J Pemán, P Calvillo, J Martínez, N Carpio, I Jarque, G F Sanz, M A Sanz
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 50 Issue 11 Pg. 1465-72 (Nov 2015) ISSN: 1476-5365 [Electronic] England
• PMID: 26281032 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antifungal Agents
• Echinocandins
• Lipopeptides
• Triazoles
• liposomal amphotericin B
• Granulocyte Colony-Stimulating Factor
• Amphotericin B
• Caspofungin

Topics

• Administration, Oral
• Adult
• Aged
• Allografts
• Amphotericin B (therapeutic use)
• Antifungal Agents (administration & dosage, therapeutic use)
• Aspergillosis (drug therapy, epidemiology, etiology)
• Caspofungin
• Cause of Death
• Drug Therapy, Combination
• Echinocandins (therapeutic use)
• Female
• Fungemia (drug therapy, epidemiology, etiology)
• Granulocyte Colony-Stimulating Factor (therapeutic use)
• Hematologic Neoplasms (therapy)
• Hematopoietic Stem Cell Transplantation
• Humans
• Immunocompromised Host
• Incidence
• Lipopeptides
• Male
• Medication Adherence
• Middle Aged
• Mycoses (drug therapy, epidemiology, etiology, prevention & control)
• Neutropenia (prevention & control)
• Patient Compliance
• Premedication
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Survival Analysis
• Transplantation Conditioning (adverse effects)
• Treatment Failure
• Triazoles (administration & dosage, therapeutic use)
• Young Adult