Incidence and risk factors of post-engraftment invasive fungal disease in adult allogeneic hematopoietic stem cell transplant recipients receiving oral azoles prophylaxis.
Por:
Montesinos P, Rodríguez-Veiga R, Boluda B, Martínez-Cuadrón D, Cano I, Lancharro A, Sanz J, Arilla MJ, López-Chuliá F, Navarro I, Lorenzo I, Salavert M, Pemán J, Calvillo P, Martínez J, Carpio N, Jarque I, Sanz GF and Sanz MA
Publicada:
1 nov 2015
Resumen:
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.
Filiaciones:
Montesinos P:
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
Rodríguez-Veiga R:
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
Boluda B:
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
Martínez-Cuadrón D:
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
Cano I:
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
Lancharro A:
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
Sanz J:
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
Arilla MJ:
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
:
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
Navarro I:
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
Lorenzo I:
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
Salavert M:
Department of Infectious Diseases, Hospital Universitari i Politècnic La Fe, València, Spain
Pemán J:
Department of Microbiology, Hospital Universitari i Politècnic La Fe, València, Spain
Calvillo P:
Department of Radiology, Hospital Universitari i Politècnic La Fe, València, Spain
Martínez J:
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
Carpio N:
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
Jarque I:
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
Sanz GF:
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
Sanz MA:
Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain
Departament de Medicina, Universitat de València, Valencia, Spain
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