In:
Transplant Infectious Disease, Wiley, Vol. 15, No. 3 ( 2013-06), p. 243-250
Abstract:
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.
Type of Medium:
Online Resource
ISSN:
1398-2273
,
1399-3062
DOI:
10.1111/tid.2013.15.issue-3
Language:
English
Publisher:
Wiley
Publication Date:
2013
detail.hit.zdb_id:
2010983-0
detail.hit.zdb_id:
1476094-0
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