Premium
Risk factors for recurrence of invasive fungal infection during secondary antifungal prophylaxis in allogeneic hematopoietic stem cell transplant recipients
Author(s) -
Liu F.,
Wu T.,
Wang J.B.,
Cao X.Y.,
Yin Y.M.,
Zhao Y.L.,
Lu D.P.
Publication year - 2013
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12068
Subject(s) - medicine , caspofungin , voriconazole , neutropenia , fluconazole , hematopoietic stem cell transplantation , transplantation , itraconazole , micafungin , risk factor , contraindication , retrospective cohort study , gastroenterology , surgery , antifungal , chemotherapy , pathology , alternative medicine , dermatology
Background Invasive fungal infections ( IFI s) are a major cause of mortality among allogeneic hematopoietic stem cell transplantation (allo‐ HSCT ) patients. Thanks to the widespread use of secondary antifungal prophylaxis ( SAP ), a history of IFI is not an absolute contraindication to allo‐ HSCT . However, IFI recurrence remains a risk factor for transplant‐related mortality. Methods To evaluate the risk factors for IFI recurrence in allo‐ HSCT patients receiving SAP , we performed a retrospective analysis of 90 individuals treated at our hospital. SAP antifungal agents included fluconazole ( n = 28), voriconazole ( n = 25), itraconazole ( n = 23), caspofungin ( n = 7), and micafungin ( n = 7). Results By day +100, recurrent IFI had occurred in 23 (25.5%) patients. Our multivariate analysis identified 4 factors significantly associated with a risk of IFI recurrence within 100 days of allo‐ HSCT : duration of neutropenia >18 days, presence of severe acute graft‐versus‐host disease ( aGVHD ), <70‐day interval between previous infection and transplantation, and use of a narrow‐spectrum SAP agent ( P = 0.008, 0.010, 0.041, and 0.001, respectively). Of the 87 patients who remained in the study for the duration of the follow‐up period (median length: 551 days), 26 (29.9%) died; only 7 (8.0%) of these deaths resulted from a severe fungal infection. Conclusion These results suggest that transplantation outcome can be improved by adequate antifungal treatment before transplantation, better prevention of, and therapy for, severe aGVHD , use of granulocyte colony‐stimulating factor to reduce the duration of neutropenia, and use of broad‐spectrum prophylaxis agents.