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Infections

Incidence and risk factors of post-engraftment invasive fungal disease in adult allogeneic hematopoietic stem cell transplant recipients receiving oral azoles prophylaxis

Bone Marrow Transplantation volume 50, pages 1465–1472 (2015)Cite this article

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Abstract

Studies that analyze the epidemiology and risk factors for invasive fungal disease (IFD) after engraftment in alloSCT are few in number. This single-center retrospective study included 404 alloSCT adult recipients surviving >40 days who engrafted and were discharged without prior IFD. All patients who received ⩾20 mg/day of prednisone were assigned to primary oral prophylaxis (itraconazole or low-dose voriconazole). The primary end point was the cumulative incidence (CI) of probable/proven IFD using the European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC/MSG) criteria. The independent prognostic factors after multivariate analyses were used to construct a post-engraftment IFD risk score. The 1-year CI of IFD was 11%. The non-relapse mortality was 40% in those developing IFD and 16% in those who did not. The intent-to-treat analysis showed that 17% of patients abandoned the assigned prophylaxis. Age >40 years, ⩾1 previous SCT, pre-engraftment neutropenia >15 days, extensive chronic GVHD and CMV reactivation were independent risk factors. The post-engraftment IFD score stratified patients into low risk (0–1 factor, CI 0.7%), intermediate risk (2 factors, CI 9.9%) and high risk (3–5 factors, CI 24.7%) (P<0.0001). The antifungal prophylaxis strategy failed to prevent post-engraftment IFD in 11% of alloSCT. Our risk score could be useful to implement risk-adapted strategies using antifungal prophylaxis after engraftment.

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Acknowledgements

We thank Paula Petruskevicius, Carlos Pastorini, David Pellicer and Shirley Weiss for data collection and management. This study was in part supported by grant 2012/023 from the Instituto de Investigación Sanitaria La Fe. This paper was supported by an independent medical grant provided by Pfizer, Inc.

Author contributions

PM, RR-V and MAS conceived the study, analyzed and interpreted the data; PM and RR-V wrote the paper and performed the statistical analyses; BB, DM-C, IC, AL, JS, MJA, FL-C, IN, IL, MS, JP, JM, NC, IJ and GFS reviewed the manuscript and contributed to the final draft.

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Authors and Affiliations

  1. Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain

    P Montesinos, R Rodríguez-Veiga, B Boluda, D Martínez-Cuadrón, I Cano, A Lancharro, J Sanz, M J Arilla, F López-Chuliá, I Navarro, I Lorenzo, J Martínez, N Carpio, I Jarque, G F Sanz & M A Sanz

  2. Department of Infectious Diseases, Hospital Universitari i Politècnic La Fe, València, Spain

    M Salavert

  3. Department of Microbiology, Hospital Universitari i Politècnic La Fe, València, Spain

    J Pemán

  4. Department of Radiology, Hospital Universitari i Politècnic La Fe, València, Spain

    P Calvillo

  5. Departament de Medicina, Universitat de València,, Valencia,, Spain

    M A Sanz

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  1. P Montesinos
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  18. G F Sanz
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Correspondence to P Montesinos.

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Montesinos, P., Rodríguez-Veiga, R., Boluda, B. et al. Incidence and risk factors of post-engraftment invasive fungal disease in adult allogeneic hematopoietic stem cell transplant recipients receiving oral azoles prophylaxis. Bone Marrow Transplant 50, 1465–1472 (2015). https://doi.org/10.1038/bmt.2015.181

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