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ctt-journal > Popova et al. (Abstract)

Popova et al. (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 12
doi: 10.3205/ctt-2011-No12-abstract66

© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "5th Raisa Gorbacheva Memorial Meeting Hematopoietic Stem Cell Transplantation in Children and Adults", Saint Petersburg, Russia, September 18–20, 2011

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Epidemiology and outcome of invasive fungal diseases in adult autologous hematopoietic stem cell transplant recipients

Marina O. Popova1, Vladimir N. Vavilov1, Alisa G. Volkova1, Ilya S. Zyuzgin2, Ludmila S. Zubarovskaya1, Nikolay N. Klimko3, Boris V. Afanasyev1

1R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University, St. Petersburg, Russia; 2Leningrad Regional Clinical Hospital, St. Petersburg, Russia; 3Dept. of Clinical Mycology, St. Petersburg Medical Academy of Postgraduate Education, Russia

Correspondence: Marina O. Popova, R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, St. Petersburg Pavlov State Medical University, 6/8, Tolstoy str., St. Petersburg, 197022, Russia, E-mail: marina.popova.spb@spam is badgmail.com

Abstract

Background: Invasive fungal diseases (IFD) are the one of leading causes of morbidity and mortality in hematopoietic stem cell transplant (HSCT) recipients. It is believed that autologous hematopoietic stem cell transplant recipients have a low risk of IFD. This study focuses on the risk factors, etiology, and outcomes of IFD in this group of patients.

Methods: The study consisted of 119 pts aged 18–67 (median 33 y.o.), predominantly with lymphoma (81%) after autologous (auto) HSCT between 2000 through 2010. At the moment of HSCT 73% and 27% patients were in remission and in relapse respectively. Sources of HSC: PBSC: 73%, and BM: 27%. Myeloablative conditioning was used in 100% of cases. Fluconazole was mostly used like antifungal prophylaxis (93%). The distribution of IFD and rates of overall survival (OS) at 12 weeks after diagnosis and 1 year after HSCT were studied. Probable and proven IFD criteria according EORTC/MSG 2008 classification were used.

Results: The incidence of IFD after autoHSCT was 10.9% (13/119). Invasive aspergillosis (IA) 84.6% was the most frequent IFD, and invasive candidiasis (IC) 15.4%. The incidence of IA after autoHSCT was 9.2% (11/119). IA were caused by Aspergillus spp.: A. fumigatus 54.5%, A. niger 18.2%, A. flavus 9.1%, and unidentified Aspergillus spp. 18.2%. The median date of IA onset was D+11 (6–38) after HSCT. The incidence of IC after autoHSCT was 1.7% (2/119). One case of IC was caused by Candida albicans, and the second case was C. glabrata. The median date of IC onset was D+24.5 (6–43) after HSCT. The following risk factors were detected: IFD before HSCT, mucositis grade III–IV, lymphopenia more than 3 weeks, neutropenia grade 4 more than 2 weeks, and severe bacterial infection/sepsis (p<0.05). Unexpectedly, the receipt of G-CSF for engraftment was associated with an increased risk of IFD (p<0.001). The 12-week OS after diagnosis was better for autoHSCT recipients with IA (86%), than those with IC (50%). The 1-year OS after HSCT in pts with remission of underlining disease at the moment of HSCT with IFD vs. without IFD was 81% vs. 84% (p=0.7); but the 1-year OS after HSCT in pts with relapse of underlying disease at the moment of HSCT with IFD vs. without IFD was 39% vs. 74% (p=0.1).

Conclusion: The incidence of IFD and large proportion of IA following autoHSCT was higher than expected due to Aspergillus non-fumigatus etiology. Receipt of G-CSF was detected as a new risk factor for IFD in autoHSCT recipients. The 12-week survival rate was better for autoHSCT recipients with IA than those with IC, who had the highest mortality rate. The 1-year OS after autoHSCT decreased in pts with IFD when HSCT was done during relapse of the underlying disease.

Keywords: Autologous HSCT, invasive fungal diseases, invasive aspergillosis, invasive candidiasis