European journal of haematology · 2019
Invasive fungal disease in patients undergoing umbilical cord blood transplantation after myeloablative conditioning regimen.
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Montoro Juan, Sanz Jaime, Lorenzo José I, Montesinos Pau, Rodríguez-Veiga Rebeca, Salavert Miguel, González Eva, Guerreiro Manuel, Carretero Carlos, Balaguer Aitana, Gómez Inés, Solves Pilar, Sanz Guillermo F, Sanz Miguel A, Piñana José L
Аннотация
OBJECTIVE: Characteristics and risk factors (RFs) of invasive fungal disease (IFD) have been little studied in the setting of umbilical cord blood transplantation (UCBT).
METHOD: We retrospectively included 205 single-unit myeloablative UCBT recipients with a median follow-up of 64 months.
RESULTS: Fifty-six episodes of IFD were observed in 48 patients (23%) at a median time of 123 days after stem cell infusion. Invasive mold disease (IMD) occurred in 42 cases, 38 of them (90%) caused by invasive aspergillosis whereas invasive yeast disease (IYD) occurred in 14 cases, most of them due to candidemia (n = 12, 86%). The 5-year cumulative incidence of IFD, IMDs, and IYDs was 24% 19%, and 7%, respectively. In multivariate analysis, three RFs for IMDs were identified: age >30 years (HR 3.5, P = 0.017), acute grade II-IV graft-versus-host disease (HR 2.3, P = 0.011), and ≥1 previous transplant (HR 3.1, P = 0.012). The probability of IMDs was 2.5%, 14%, and 33% for recipients with none, 1, or 2-3 RFs, respectively (P < 0.001). Among IFD, IMDs had a negative effect on non-relapse mortality in multivariate analysis (HR 1.6, P = 0.039). IMDs showed a negative impact on overall survival (HR 1.59, P = 0.018).
CONCLUSION: Invasive mold disease were very common and serious complication after UCBT.
METHOD: We retrospectively included 205 single-unit myeloablative UCBT recipients with a median follow-up of 64 months.
RESULTS: Fifty-six episodes of IFD were observed in 48 patients (23%) at a median time of 123 days after stem cell infusion. Invasive mold disease (IMD) occurred in 42 cases, 38 of them (90%) caused by invasive aspergillosis whereas invasive yeast disease (IYD) occurred in 14 cases, most of them due to candidemia (n = 12, 86%). The 5-year cumulative incidence of IFD, IMDs, and IYDs was 24% 19%, and 7%, respectively. In multivariate analysis, three RFs for IMDs were identified: age >30 years (HR 3.5, P = 0.017), acute grade II-IV graft-versus-host disease (HR 2.3, P = 0.011), and ≥1 previous transplant (HR 3.1, P = 0.012). The probability of IMDs was 2.5%, 14%, and 33% for recipients with none, 1, or 2-3 RFs, respectively (P < 0.001). Among IFD, IMDs had a negative effect on non-relapse mortality in multivariate analysis (HR 1.6, P = 0.039). IMDs showed a negative impact on overall survival (HR 1.59, P = 0.018).
CONCLUSION: Invasive mold disease were very common and serious complication after UCBT.