Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Invasive aspergillosis in patients following umbilical cord blood transplant

Bone Marrow Transplantation volume 54, pages 308–311 (2019)Cite this article

Subjects

Umbilical cord blood (UCB) can be used for hematopoietic stem cell transplantation (HSCT) in patients who do not have an optimally matched donor [1]. Although human leukocyte antigen system (HLA) mismatch is increased when using UCB cells, the increased immunologic naivety of UCB units permits the use of units that are mismatched by one or two HLA alleles without an adverse effect on graft function [2]. However, when compared with traditional HSCT, engraftment is delayed following umbilical cord blood transplant (UCBT), resulting in prolonged periods of profound neutropenia [3, 4]. Because UCBT recipients remain neutropenic for a longer time, they are at increased risk of invasive mold infections with associated high mortality [5]. Invasive aspergillosis (IA) remains the most common mold infection following HSCT [5, 6]. Currently, there are limited data on the occurrence of IA among UCBT recipients [7,8,9,10]. We sought to describe the clinical features and outcomes of this infection over 12 years in our cohort of UCBT recipients.

This retrospective study was conducted at the University of Michigan Health System, Ann Arbor, MI, and Karmanos Cancer Center, Detroit, MI. All adult patients, ≥18 years of age, who underwent UCBT between January 1, 2006 and December 31, 2015 were enrolled if they developed IA, as defined by EORTC/MSG criteria [11]. Medical records were reviewed to identify infectious and other complications for 2 years following UCBT.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Ballen KK, Gluckman E, Broxmeyer HE. Umbilical cord blood transplantation: the first 25 years and beyond. Blood. 2013;122:491–8.

    Article  CAS  Google Scholar 

  2. Hwang WY, Samuel M, Tam D, Koh LP, Lim W, Linn YC. A meta-analysis of unrelated donor umbilical cord blood transplantation versus unrelated donor bone marrow transplant in adult and pediatric patients. Biol Blood Marrow Transpl. 2007;13:444–53.

    Article  Google Scholar 

  3. Inoue H, Yasuda Y, Hattori K, Shimizu T, Matsumoto M, Yabe M, et al. The kinetics of immune reconstitution after cord blood transplantation and selected CD34+ stem cell transplantation in children: comparison with bone marrow transplantation. Int J Hematol. 2003;77:399–407.

    Article  Google Scholar 

  4. Ramirez P, Brunstein CG, Miller B, Defor T, Weisdorf D. Delayed platelet recovery after allogeneic transplantation: a predictor of increased treatment-related mortality and poorer survival. Bone Marrow Transpl. 2011;46:981–6.

    Article  CAS  Google Scholar 

  5. Kontoyiannis DP, Marr KA, Park BJ, Alexander BD, Anaissie EJ, Walsh TJ, et al. Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001–2006: overview of the Transplant-Associated Infection Surveillance Network (TRANSNET) database. Clin Infect Dis. 2010;50:1091–100.

    Article  Google Scholar 

  6. Upton A, Kirby KA, Carpenter P, Boeckh M, Marr KA. Invasive aspergillosis following hematopoietic cell transplantation: outcomes and prognostic factors associated with mortality. Clin Infect Dis. 2007;44:531–40.

    Article  Google Scholar 

  7. Martino R, Bautista G, Parody R, García I, Esquirol A, Rovira M, et al. Severe infections after single umbilical cord blood transplantation in adults with or without the co-infusion of CD34+ cells from a third-party donor: results of a multicenter study from the Grupo Español de Trasplante Hematopoyetico (GETH). Transpl Infect Dis. 2015;17:221–33.

    Article  CAS  Google Scholar 

  8. Miyakoshi S, Kusumi E, Matsumura T, Hori A, Murashige N, Hamaki T, et al. Invasive fungal infection following reduced intensity cord blood transplantation for adult patients with hematologic diseases. Biol Blood Marrow Transpl. 2007;13:771–7.

    Article  CAS  Google Scholar 

  9. Parody R, Martino R, Rovira M, Vazquez L, Vázquez MJ, de la Cámara R, et al. Severe infections after unrelated donor allogeneic hematopoietic stem cell transplantation in adults: comparison of cord blood transplantation with peripheral blood and bone marrow transplantation. Biol Blood Marrow Transpl. 2006;12:734–48.

    Article  Google Scholar 

  10. Parody R, Martino R, de la Cámara R, García-Noblejas A, Esquirol A, Garcia-Cadenas I, et al. Fungal and viral infections after allogeneic hematopoietic transplantation from unrelated donors in adults: improving outcomes over time. Bone Marrow Transpl. 2015;50:274–81.

    Article  CAS  Google Scholar 

  11. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, et al. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) consensus group. Clin Infect Dis. 2008;46:1813–21.

    Article  Google Scholar 

  12. Harrison N, Mitterbauer M, Tobudic S, Kalhs P, Rabitsch W, Greinix H, et al. Incidence and characteristics of invasive fungal diseases in allogeneic hematopoietic stem cell transplant recipients: a retrospective cohort study. BMC Infect Dis. 2015;15:584–93.

    Article  Google Scholar 

  13. Mikulska M, Raiola AM, Bruno B, Furfaro E, Van Lint MT, Bregante S, et al. Risk factors for invasive aspergillosis and related mortality in recipients of allogeneic SCT from alternative donors: an analysis of 306 patients. Bone Marrow Transpl. 2009;44:361–70.

    Article  CAS  Google Scholar 

  14. van Burik JH, Ratanatharathorn V, Stepan DE, Miller CB, Lipton JH, Vesole DH, et al. Micafungin versus fluconazole for prophylaxis against invasive fungal infections during neutropenia in patients undergoing hematopoietic stem cell transplantation. Clin Infect Dis. 2004;39:1407–16.

    Article  Google Scholar 

  15. Wingard JR, Carter SL, Walsh TJ, Kurtzberg J, Small TN, Baden LR, et al. Randomized, double-blind trial of fluconazole versus voriconazole for prevention of invasive fungal infection after allogeneic hematopoietic cell transplantation. Blood. 2010;116:5111–8.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Infectious Diseases, University of Michigan Health System, Ann Arbor, MI, USA

    Kathleen A. Linder, Carol A. Kauffman & Marisa H. Miceli

  2. Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA

    Kathleen A. Linder & Carol A. Kauffman

  3. Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, MI, USA

    Philip J. McDonald, Sanjay G. Revankar & Pranatharthi H. Chandrasekar

Authors
  1. Kathleen A. Linder
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philip J. McDonald
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carol A. Kauffman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sanjay G. Revankar
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Pranatharthi H. Chandrasekar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marisa H. Miceli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marisa H. Miceli.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Linder, K.A., McDonald, P.J., Kauffman, C.A. et al. Invasive aspergillosis in patients following umbilical cord blood transplant. Bone Marrow Transplant 54, 308–311 (2019). https://doi.org/10.1038/s41409-018-0230-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41409-018-0230-5

This article is cited by

Search

Advanced search

Quick links