Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025
Invasive Fungal Disease in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation in China: A Multicenter Epidemiological Study (CAESAR 2.0).
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Li Chuan, Zhu Dan-Ping, Chen Jia, Zhu Xiao-Yu, Li Nai-Nong, Cao Wei-Jie, Zhang Zhong-Ming, Tan Ye-Hui, Hu Xiao-Xia, Yuan Hai-Long, Fang Xiao-Sheng, Yin Yue, Wang Hong-Tao, Li Nan, Huang Xiao-Jun, Sun Yu-Qian
Аннотация
BACKGROUND: This study (China Assessment of Antifungal Therapy in Hematological Diseases [CAESAR 2.0]) aimed to provide updated epidemiological data on invasive fungal disease (IFD) in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT).
METHODS: This multicenter, real-world, observational study was conducted at 12 allo-HSCT centers in China between January and December 2021. Consecutive adult patients (aged ≥18 years) who underwent allo-HSCT with antifungal prophylaxis were included. IFD was diagnosed according to the 2019 criteria of the European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC/MSG). Follow-up was completed by 31 December 2022.
RESULTS: A total of 2015 patients were included. Mold-active antifungal prophylaxis was used in 76.08%, most of whom received voriconazole (44.37%) or posaconazole (31.71%). The cumulative incidence of IFD (proven or probable) 1 year after allo-HSCT was 6.3%. Pathogens were identified in 47.97% of IFD cases and mainly included Candida spp. (17.89%), Mucorales (13.01%), Aspergillus spp. (8.94%), and Pneumocystis jirovecii (6.5%). Multivariate analysis identified the following factors associated with IFD: disease at advanced stage (hazard ratio, 2.55 [95% confidence interval, 1.58-4.12]; P < .001), absolute neutrophil count engraftment (≤28 days) (0.37 [15-.92]; P = .03), platelet engraftment (≤28 days) (0.41 [.27-.62]; P < .001), and acute graft-vs-host disease grade III-IV (2.97 [1.97-4.49]; P < .001). The IFD-attributable mortality rate was 48.28%.
CONCLUSIONS: Despite the widespread use of mold-active prophylaxis, the risk of IFD after allo-HSCT remains high. The most common pathogens are Candida spp., Mucorales, Aspergillus spp., and P. jirovecii.
METHODS: This multicenter, real-world, observational study was conducted at 12 allo-HSCT centers in China between January and December 2021. Consecutive adult patients (aged ≥18 years) who underwent allo-HSCT with antifungal prophylaxis were included. IFD was diagnosed according to the 2019 criteria of the European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC/MSG). Follow-up was completed by 31 December 2022.
RESULTS: A total of 2015 patients were included. Mold-active antifungal prophylaxis was used in 76.08%, most of whom received voriconazole (44.37%) or posaconazole (31.71%). The cumulative incidence of IFD (proven or probable) 1 year after allo-HSCT was 6.3%. Pathogens were identified in 47.97% of IFD cases and mainly included Candida spp. (17.89%), Mucorales (13.01%), Aspergillus spp. (8.94%), and Pneumocystis jirovecii (6.5%). Multivariate analysis identified the following factors associated with IFD: disease at advanced stage (hazard ratio, 2.55 [95% confidence interval, 1.58-4.12]; P < .001), absolute neutrophil count engraftment (≤28 days) (0.37 [15-.92]; P = .03), platelet engraftment (≤28 days) (0.41 [.27-.62]; P < .001), and acute graft-vs-host disease grade III-IV (2.97 [1.97-4.49]; P < .001). The IFD-attributable mortality rate was 48.28%.
CONCLUSIONS: Despite the widespread use of mold-active prophylaxis, the risk of IFD after allo-HSCT remains high. The most common pathogens are Candida spp., Mucorales, Aspergillus spp., and P. jirovecii.