Risk factors for invasive yeast infections in adult patients with hematological malignancies and/or stem cell transplant: systematic literature review and meta-analysis.

BACKGROUND

Invasive yeast infections (IYI) are a major threat to patients with hematological malignancies. We conducted a systematic review and meta-analysis to identify risk factors.

METHODS

Cohort and case-control studies were included if ≥ 90% of participants were adults and ≥ 90% had hematological malignancies or underwent hematopoietic stem cell transplant (HSCT), and if they reported risk factors for IYI. Searches were performed in PubMed, Embase, CENTRAL, ClinicalTrials.gov, and relevant conference proceedings from inception to January 23rd 2025. Two reviewers independently screened full texts, extracted data, and assessed methodological quality using CASP checklists. Adjusted measure effects were pooled using random-effects models.

RESULTS

Of 13,374 references screened, seven studies (27,925 patients, 590 IYI) were included; five were eligible for meta-analysis. All were methodologically sound. In the allo-HSCT population, among 5 risk factors pooled (two studies each), male sex (HR 1.34 [95% CI 1.09-1.65]) and prior HSCT (HR 2.72 [95% CI 1.18-6.26]) were significantly associated with IYI. Cord blood transplant was significantly associated with increased candidemia risk (HR 3.03 [95% CI 1.99-4.60]). In patients with hematological malignancies, the presence of a central venous catheter was associated with IYI (OR 6.19 [95% CI 2.65-14.46]).

CONCLUSIONS

Risk factors associated with IYI were male sex and prior HSCT in the allo-HSCT population, and the presence of a central venous catheter in patients with hematological malignancies. Cord blood transplant was associated with an increased risk of candidemia. Increased vigilance in patients displaying these risk factors should be encouraged.

REGISTRATION: PROSPERO, CRD42023429103.