Abstract
Despite new antifungal treatment strategies, invasive aspergillosis (IA) remains a principal cause of infectious mortality after bone marrow transplantation (BMT). We reviewed the medical records of 93 allogeneic and 149 autologous transplant recipients during a 20 month period, with attention to cases of proven or probable IA. No autologous transplant recipient developed IA, whereas IA was seen in 15.1% of allogeneic recipients (including two of five patients with a prior history of IA despite prophylaxis), for an overall incidence of 5.8%. The median time to occurrence was 92 days post transplant, with no de novo cases developing prior to engraftment. Survival 100 days from diagnosis was 29%. Risk factors for the development of IA included ⩾21 days of corticosteroid therapy of ⩾1 mg/kg/day and post-transplant cytomegalovirus (CMV) infection. These two risk factors were statistically linked. Our data illustrate a shift toward a later occurrence of post-transplant IA, suggesting a need for close, prolonged surveillance in the outpatient environment. The contributory role of protracted corticosteroid use is also highlighted. These data have important implications in an era of alternate donor transplants and more intense immunosuppression. Established strategies implementing newer, less toxic antifungal agents as prophylaxis in high-risk patients are needed.
Bone Marrow Transplantation (2002) 29, 15–19. doi:10.1038/sj.bmt.1703332
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References
Ribaud P, Chastang C, Latge JP et al. Survival and prognostic factors of invasive aspergillosis after allogeneic bone marrow transplantation Clin Infect Dis 1999 28: 322 330
Navarro E, Lecriones J, Witebsky F et al. Invasive aspergillosis developing during empirical antifungal therapy. In: Abstracts of the 90th Annual Meeting of the American Society for Microbiology. Washington 1990 Abstr. F71
Meyers J . Fungal infections in bone marrow transplant patients Semin Oncol 1990 17: 10 13
Jantunen E, Ruutu P, Niskanen L et al. Incidence and risk factors for invasive fungal infections in allogeneic BMT recipients Bone Marrow Transplant 1997 19: 801 08
Wald A, Leisenring W, van Burik JA et al. Epidemiology of Aspergillus infections in a large cohort of patients undergoing bone marrow transplantation J Infect Dis 1997 175: 1459 1466
Wingard JR, Beals SU, Santos GW et al. Aspergillus infections in bone marrow transplant recipients Bone Marrow Transplant 1987 2: 175 181
Tollemar J, Ringdén O, Boström L et al. Variables predicting deep fungal infections in bone marrow transplant recipients Bone Marrow Transplant 1989 4: 635 641
Guiot HFL, Fibbe WE, van ‘t Wout JW . Risk factors for fungal infection in patients with malignant hematologic disorders: implications for empirical therapy and prophylaxis Clin Infect Dis 1994 18: 525 532
O'Donnell MR, Schmidt GM, Tegtmeier BR et al. Prediction of systemic fungal infection in allogeneic marrow recipients: impact of amphotericin prophylaxis in high-risk patients J Clin Oncol 1994 12: 827 834
McWhinney PHM, Kibbler CC, Hamon MD et al. Progress in the diagnosis and management of aspergillosis in bone marrow transplantation: a 13 years’ experience Clin Infect Dis 1993 17: 397 404
Sherertz RJ, Belani A, Kramer BS et al. Impact of air filtration on nosocomial aspergillus infections: unique risk of bone marrow transplant recipients Am J Med 1987 83: 709 718
Przepiorka D, Weisdorf D, Martin P et al. Consensus conference on acute GVHD grading Bone Marrow Transplant 1995 15: 825 828
Dix SP, Yee GC . Pharmacologic and biologic agents. In: Whedon MB, Wujick D (eds). Blood and Marrow Translantation: Principles, Practice, and Nursing Insights, 2nd edn Jones and Bartlett Publishers: Sudbury, MA 1997 pp 100 150
Ellis M, Spence D, Meunier F et al. An EORTC International Multicenter Randomized Trial (EORTC Number 19923) comparing two dosages of liposomal amphotericin B for treatment of invasive aspergillosis Clin Infect Dis 1998 27: 406 412
Husni RN, Gordon SM, Longworth DL et al. Cytomegalovirus infection is a risk factor for invasive aspergillosis in lung transplant recipients Clin Infect Dis 1998 26: 753 755
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Grow, W., Moreb, J., Roque, D. et al. Late onset of invasive aspergillus infection in bone marrow transplant patients at a university hospital. Bone Marrow Transplant 29, 15–19 (2002). https://doi.org/10.1038/sj.bmt.1703332
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DOI: https://doi.org/10.1038/sj.bmt.1703332
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