TY - JOUR
T1 - Invasive mold infections in acute leukemia patients undergoing allogeneic hematopoietic stem cell transplantation
AU - Chien, Sheng Hsuan
AU - Liu, Yao Chung
AU - Liu, Chia Jen
AU - Ko, Po Shen
AU - Wang, Hao Yuan
AU - Hsiao, Liang Tsai
AU - Chiou, Tzeon Jye
AU - Liu, Jin Hwang
AU - Gau, Jyh Pyng
N1 - Funding Information:
This work was partially supported by grants from the Taipei Veterans General Hospital- National Yang-Ming University Excellent Physician Scientists Cultivation Program, No. 105-V-B-113 , Taipei Veterans General Hospital (grant no. V106C-193 ), the Taiwan Clinical Oncology Research Foundation , and the Chong Hin Loon Memorial Cancer and Biotherapy Research Center . The funding sources had no role in the study design or conduct, or in the decision to submit it for publication. We thank Hsin-Yi Huang from the Biostatistics Task Force, Taipei Veterans General Hospital, for the statistical assistance.
Funding Information:
This work was partially supported by grants from the Taipei Veterans General Hospital-National Yang-Ming University Excellent Physician Scientists Cultivation Program, No. 105-V-B-113, Taipei Veterans General Hospital (grant no. V106C-193), the Taiwan Clinical Oncology Research Foundation, and the Chong Hin Loon Memorial Cancer and Biotherapy Research Center. The funding sources had no role in the study design or conduct, or in the decision to submit it for publication. We thank Hsin-Yi Huang from the Biostatistics Task Force, Taipei Veterans General Hospital, for the statistical assistance.
Publisher Copyright:
© 2018
PY - 2019/12
Y1 - 2019/12
N2 - Background/purpose: Patients with acute leukemia undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) are exposed to high risk of developing invasive fungal infections, and the invasive mold infections (IMIs) are becoming more and more common after transplantation. Here, we conducted a retrospective study to analyze demographics, microbiology, and risk factors for IMIs development in adult acute leukemia patients undergoing allo-HSCT. Methods: We reviewed 245 adult acute leukemia patients undergoing allo-HSCT from January 2003 to December 2014. Clinical characteristics including age, sex, conditioning regimens, European Group for Blood and Bone marrow Transplantation (EBMT) risk score, and presence of acute graft-versus-host disease (aGVHD) or chronic GVHD (cGVHD) were collected and analyzed. Cox proportional hazard model was adopted to explore the independent risk factors for IMIs developments. Results: Seventeen of 245 patients developed IMIs during the study period. The cumulative incidence of IMIs in this cohort was 8.7% and 16.8% at 6 and 12 months, respectively, with Aspergillus species being the most common pathogen. The significant risk factors predicting IMIs were unrelated donor transplantation (hazard ratio [HR] 5.11), smoking (HR 3.55), EBMT risk score > 2 (HR 4.22), and moderate to severe cGVHD (HR 3.76). Conclusions: We identified four risk factors-unrelated donor transplantation, smoking, EBMT risk score >2 and moderate to severe cGVHD to predict IMIs among acute leukemia patients undergoing allo-HSCT. This cohort study suggests early identification of high-risk patients and to provide better prevention strategies would reduce the incidence and severity of IMIs in these patients.
AB - Background/purpose: Patients with acute leukemia undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) are exposed to high risk of developing invasive fungal infections, and the invasive mold infections (IMIs) are becoming more and more common after transplantation. Here, we conducted a retrospective study to analyze demographics, microbiology, and risk factors for IMIs development in adult acute leukemia patients undergoing allo-HSCT. Methods: We reviewed 245 adult acute leukemia patients undergoing allo-HSCT from January 2003 to December 2014. Clinical characteristics including age, sex, conditioning regimens, European Group for Blood and Bone marrow Transplantation (EBMT) risk score, and presence of acute graft-versus-host disease (aGVHD) or chronic GVHD (cGVHD) were collected and analyzed. Cox proportional hazard model was adopted to explore the independent risk factors for IMIs developments. Results: Seventeen of 245 patients developed IMIs during the study period. The cumulative incidence of IMIs in this cohort was 8.7% and 16.8% at 6 and 12 months, respectively, with Aspergillus species being the most common pathogen. The significant risk factors predicting IMIs were unrelated donor transplantation (hazard ratio [HR] 5.11), smoking (HR 3.55), EBMT risk score > 2 (HR 4.22), and moderate to severe cGVHD (HR 3.76). Conclusions: We identified four risk factors-unrelated donor transplantation, smoking, EBMT risk score >2 and moderate to severe cGVHD to predict IMIs among acute leukemia patients undergoing allo-HSCT. This cohort study suggests early identification of high-risk patients and to provide better prevention strategies would reduce the incidence and severity of IMIs in these patients.
KW - Acute leukemia
KW - Allogeneic hematopoietic stem cell transplantation
KW - Graft-versus-host disease
KW - Mold infection
KW - Smoking
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U2 - 10.1016/j.jmii.2018.09.006
DO - 10.1016/j.jmii.2018.09.006
M3 - Article
C2 - 30322746
AN - SCOPUS:85054697953
SN - 1684-1182
VL - 52
SP - 973
EP - 982
JO - Journal of Microbiology, Immunology and Infection
JF - Journal of Microbiology, Immunology and Infection
IS - 6
ER -
