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Infections after Transplant

Risk factors for post-engraftment invasive aspergillosis in allogeneic stem cell transplantation

Bone Marrow Transplantation volume 34, pages 115–121 (2004)Cite this article

Summary:

The majority of invasive aspergillosis (IA) in allogeneic stem cell transplantation (SCT) occurs during the post-engraftment period. We used Cox proportional hazards regression to evaluate post-engraftment IA risk in a cohort of 217 allogeneic SCT recipients from 1991 to 1998. The aim was to quantify the effects of dose-intensity and duration of corticosteroids and other risk factors. Median duration of follow-up was 330 days. There were 19 cases of IA (overall 8.8%) with 14 post-engraftment infections. In the final model, the risk of IA was greatest within 2 weeks of high-dose corticosteroids (HR 8.5, P=0.003), with risk extending to 4 weeks with doses of 0.25–1 mg/kg/day (HR 3.1, P=0.08). Ganciclovir was associated with greatest risk (HR 13.6). Grade 3 or 4 acute GVHD (HR 5.7) and secondary neutropenia (HR=1.3) were also additive risks. In the univariate analysis, corticosteroid doses of 0.25–1.0 mg/kg/day for any duration between 2 and 10 weeks demonstrated prolonged risk for IA. Moderate doses of corticosteroids can confer an increased risk for IA for extended periods which is almost as marked as that conferred by higher doses. Knowledge of these risks may facilitate the development of targeted surveillance and prophylaxis strategies for prevention of IA.

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Acknowledgements

Many thanks to Peter and Ann-Marie Sherman who collected all data for this study, and to Thao Nguyen for data entry and validation. Supported by a grant from Gilead Sciences (MS). The supporting source had no role in the study design, data collection and analysis, or the interpretation and writing of the manuscript. The authors declare no competing interests with regard to the material published in this article.

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Authors and Affiliations

  1. Victorian Infectious Diseases Service and National Health and Medical Research Council Centre of Clinical Research Excellence in Infectious Diseases, Royal Melbourne Hospital, Melbourne, Australia

    K Thursky & M Slavin

  2. Department of Mathematics and Statistics, University of Melbourne, Melbourne, Australia

    G Byrnes

  3. Department of Clinical Haematology and Medical Oncology, Bone Marrow Transplant Service, Royal Melbourne Hospital, Melbourne, Australia

    A Grigg & J Szer

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  1. K Thursky
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  2. G Byrnes
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Correspondence to K Thursky.

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Thursky, K., Byrnes, G., Grigg, A. et al. Risk factors for post-engraftment invasive aspergillosis in allogeneic stem cell transplantation. Bone Marrow Transplant 34, 115–121 (2004). https://doi.org/10.1038/sj.bmt.1704543

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