Clinical characteristics and risk factors of invasive fungal disease after hematopoietic stem cell transplantation: report of 233 cases

Abstract

Objective To investigate the clinical characteristics of invasive fungal disease (IFD) after hematopoietic stem cell transplantation (HSCT) in the patients with hematological diseases, and analyze the risk factors of IFD after HSCT. Methods A retrospective study was conducted on 233 patients with hematological diseases treated by HSCT in our department from 2016 to 2018. Clinical data, including age, underlying diseases, complications, neutropenia time and other data were collected and analyzed for the clinical characteristics and risk factors of IFD among these patients. Results Among the 233 patients, 41 were diagnosed as IFD, with a total incidence of 17.6%, and 7 cases (proven cases) of them were based on fungal detection and the other 34 cases (probable cases) on clinical manifestations. The mortality rate was 46.3% in the cohort. Meanwhile, out of the 41 proven/probable IFD, 32 cases (78.0%) were breakthrough invasive fungal disease, with a total incidence of 13.7% and a mortality rate of 51.5%. The therapeutic effect on IFD before HSCT was related to the occurrence of IFD after the transplantation. Among the 41 IFD patients, 19.5% were invasive candidiasis, 80.5% were invasive mold disease, 17.1% were bloodstream infection and 82.9% were pulmonary infection. The main pathogens detected were non-Candida albicans. Univariate analysis revealed that allogeneic HSCT, previous history of IFD, cytomegalovirus (CMV) infection, EB virus infection, underlying lung diseases, neutropenia >14 d and usage of high-dose glucocorticoid were risk factors of IFD, and multivariate analysis suggested that previous history of IFD, EB virus infection, underlying lung diseases, neutropenia >14 d and usage of high-dose glucocorticoid were independent risk factors of IFD. Among the allogeneic HSCT recipients, multivariate analysis suggested that chronic graft-versus-host disease (cGVHD) was also independent risk factors of IFD. The risk factor of bIFD in proven/probable IFD was neutropenia >14 d. Conclusion The incidence and mortality of invasive fungal diseases after HSCT are quite high, and the percentage of breakthrough IFD is also high. IFD after HSCT is mainly invasive mold disease and commonly in the lung. Previous history of IFD, EB virus infection, underlying lung diseases, neutropenia >14 d, and usage of high-dose glucocorticoid increase the risk of IFD after HSCT. cGVHD also contributes to the risk of IFD.

Keywords

• hematopoietic stem cell transplantation
• invasive fungal infections
• breakthrough invasive fungal infections
• risk factors