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High rate of invasive fungal infections after non-T cell depleted haploidentical allo-HSCT even under antifungal prophylaxis

Bone Marrow Transplantation volume 56, pages 1750–1753 (2021)Cite this article

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Invasive fungal infection (IFI) is a serious complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT), resulting in significant morbidity and mortality for patients [1]. The proportion affected is not inconsiderable: 1-year cumulative rates of IFI after HSCT range from 9.2 to 15.36% [2,3,4]. Human leukocyte antigen (HLA)-matched sibling donors are the preferred source of donor cells for allo-HSCT, although only 30% of patients are likely to find a match among siblings [5]. While improved conditioning regimens and novel strategies designed to reduce the risk of graft-versus-host disease (GVHD) have led to an increased acceptance of haploidentical donors as alternative sources of donor cells [6], prolonged immunodeficiency due to delayed immune reconstitution, long-term immunosuppressant use and a high incidence of GVHD after haploidentical HSCT have all been associated with serious infections, especially IFIs [7, 8]. Previous reports have described higher rates of IFIs with haploidentical HSCT compared with those after HLA-matched transplants [9, 10]. Limited data are available as to the use of echinocandins in the patients receiving haploidentical HSCT.

We retrospectively reviewed and analyzed the data in the Taiwan Blood and Marrow Transplantation Registry (TBMTR). The data collection and analysis in TBMTR is approved by the institutional research ethics committee of each participating hospital. Our study included 174 pediatric and adult hematology patients (aged 1–75 years) who underwent haploidentical allo-HSCT between January 2013 and December 2018 in 14 transplant centers in Taiwan. Those patients with a diagnosis of previous proven or probable IFI and continued antifungal therapy till the time of allo-HSCT will be excluded, because active IFI still probably existed at transplant in them. Anyway, those who had a history of IFI but completed the treatment and discontinued antifungal agents before allo-HSCT will still be eligible.

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Taiwan Blood and Marrow Transplantation Registry (TBMTR)

Po-Nan Wang3 and Sin-Syue Li4,5

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Authors and Affiliations

  1. Division of Hematology and Oncology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan, R.O.C.

    Ming-Yu Lien & Su-Peng Yeh

  2. Division of Hematology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.

    Jyh-Pyng Gau

  3. Division of Hematology, Department of Internal Medicine, Chang Gung Medical Foundation Linkou Branch, Taoyuan, Taiwan, R.O.C.

    Po-Nan Wang

  4. Division of Hematology/Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, R.O.C.

    Sin-Syue Li

  5. College of Medicine, National Cheng Kung University, Tainan, Taiwan, R.O.C.

    Sin-Syue Li

  6. Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.

    Ming-Shen Dai

  7. Division of Hematology/Oncology, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.

    Tsung Chih Chen

  8. Division of Oncology-Hematology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C.

    Pei-Ying Hsieh

  9. Department of Hematology and Medical Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan, R.O.C.

    Lun-Wei Chiou

  10. Department of Hematology & Oncology and Department of Clinical Pathology, Hualien Buddhist Tzu Chi Hospital, Hualien, Taiwan, R.O.C.

    Wei-Han Huang

  11. Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan, R.O.C.

    Yi-Chang Liu

  12. Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, R.O.C.

    Bor-Sheng Ko

  13. Department of Hematological Oncology, National Taiwan University Cancer Center, Taipei, Taiwan, R.O.C.

    Bor-Sheng Ko

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  1. Ming-Yu Lien
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Taiwan Blood and Marrow Transplantation Registry (TBMTR)

  • Po-Nan Wang
  •  & Sin-Syue Li

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Correspondence to Bor-Sheng Ko.

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Members of the Taiwan Blood and Marrow Transplantation Registry (TBMTR) are listed above Compliance with ethical standards.

A full list of members and their affiliations of the Taiwan Blood and Marrow Transplantation Registry (TBMTR) are listed in the Supplementary Materials (Supplement 2).

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Lien, MY., Yeh, SP., Gau, JP. et al. High rate of invasive fungal infections after non-T cell depleted haploidentical allo-HSCT even under antifungal prophylaxis. Bone Marrow Transplant 56, 1750–1753 (2021). https://doi.org/10.1038/s41409-021-01260-7

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