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Popova et al. (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 9
doi: 10.3205/ctt-2010-No9-abstract67
© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "4th Raisa Gorbacheva Memorial Meeting on Hematopoietic Stem Cell Transplantation",
Saint Petersburg, Russia, September 18–20, 2010

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Factors associated with overall survival after allogeneic and autologous hematopoietic stem cell transplantation in patients with concomitant invasive fungal infection

Marina O. Popova1, Natalia I. Zubarovskaya1, Vladimir N. Vavilov1, Alisa G. Volkova1, Sergey N. Shiriaev1, Julia V. Borzova2, Sofia N. Hostelidi2, Nikolay N. Klimko2, Boris V. Afanasyev1

1R.M. Gorbacheva Memorial Institute of Children Hematology and Transplantation, Pavlov State Medical University, Saint-Petersburg, Russia; 2Kashkin Research Institute of Medical Mycology, Saint-Petersburg Medical Academy of Postgraduate Education, Saint-Petersburg, Russia

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

Abstract

Background: Invasive fungal infection (IFI) is a leading cause of infection-related mortality following hemopoietic stem cell transplantation (HSCT).

Aim: To evaluate the incidence of IFI, and the risk factors influencing overall survival (OS) in patients undergoing HSCT.

Patients and methods: 88 adult patients (pts) (median age 32 years, range 18–67) underwent either alloHSCT (39 pts) (MRD 16 pts, MUD 21 pts, haploRD 2 pts) or autoHSCT (49 pts) after myeloablative (31 pts) and non-myeloablative (57 pts) conditioning. At the time of HSCT 54 of them were in CR and 34 in relapse of acute leukemia, lymphoma, and other malignancies.

Results: A high incidence of IFI after alloHSCT vs. autoHSCT was observed (56% and 24%, respectively) with a predominance of invasive aspergillosis (91% and 92%) vs. invasive candidiasis (4.5% and 8%). Factors associated with a significant (p<0.05) decrease of 12-week OS for allo- and autoHSCT were neutropenia >10 days (61% vs. 100%), lymphopenia >30 days (73% vs. 97%), and disseminated IFI (64% vs. 82%). Steroids 1 mg/kg and relapse at the time of HSCT were associated with a higher risk of mortality for the alloHSCT group (p<0.05). Treatment of IFI with voriconazole improved the 12-week OS (95% vs. 57%; p<0.005) following alloHSCT, but not following autoHSCT. Five-year OS in pts after alloHSCT with IFI vs. without IFI was 15% vs. 38% and 48% vs. 60% after autoHSCT (р>0.1). This was significantly influenced by profound lymphopenia (p<0.001) and disseminated IFI (p<0.001).

Conclusions: Neutropenia, lymphopenia, disseminated IFI, and voriconazole therapy are among the main risk factors influencing 12-week and 5-year OS in pts who underwent allo- and autoHSCT.

Keywords: allogeneic HSCT, autologous HSCT, invasive fungal infections, overall survival

 

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