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

Autores de IIS La Fe

• Pau Montesinos Fernández

  Autor

• Rebeca Rodríguez Veiga

  Autor

• Blanca Boluda Pascual

  Autor

• David Martínez Cuadrón

  Autor

• Isabel Cano Ferri

  Autor

• Alma Lancharro

  Autor

• Jaime Sanz Caballer

  Autor

• María Jesus Arilla Morell

  Autor

• Francisca Lopez Chulia

  Autor

• Jose Ignacio Lorenzo Herrero

  Autor

• Miguel Salavert Lletí

  Autor

• Javier Pemán García

  Autor

• María Pilar Calvillo Batlles

  Autor

• Jesus Antonio Martinez Dominguez

  Autor

• Nelly Carpio Martinez

  Autor

• Isidro Jarque Ramos

  Autor

• Guillermo Sanz Santillana

  Autor

• Miguel Ángel Sanz Alonso

  Autor

Participantes ajenos a IIS La Fe

• Navarro I

Grupos

• Hematología y Hemoterapia

• Infección Grave

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 < 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.

Keywords

• ANTIFUNGAL PROPHYLAXIS; COMPETING RISK; INFECTION; ASPERGILLOSIS; VORICONAZOLE; EPIDEMIOLOGY; ITRACONAZOLE; FLUCONAZOLE; SCT; MULTICENTER