Impact of the intensity of the pretransplantation conditioning regimen in patients with prior invasive aspergillosis undergoing allogeneic hematopoietic stem cell transplantation: a retrospective survey of the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation
Open Access
- 1 November 2006
- journal article
- research article
- Published by American Society of Hematology in Blood
- Vol. 108 (9), 2928-2936
- https://doi.org/10.1182/blood-2006-03-008706
Abstract
In this retrospective study, we analyzed the outcomes of 129 patients who underwent an allogeneic hematopoietic stem cell transplantation (allo-HSCT) and had a history of probable or proven invasive aspergillosis (IA), of whom 57 (44%) received a reduced-intensity conditioning (RIC). Overall, 27 patients with IA progressed after the allo-HSCT (cumulative incidence [CumInc] at 2 years, 22%). The variables that increased the 2-year CumInc of IA progression were (1) longer duration of neutropenia after transplantation; (2) advanced status of the underlying disease; and (3) less than 6 weeks from start of systemic anti-Aspergillus therapy and the allo-HSCT. In addition, (4) conventional myeloablative conditioning increased the risk of progression early after transplantation (before day 30) only, while 3 variables increased the risk beyond day 30 were (5) cytomegalovirus disease; (6) bone marrow or cord blood as source of stem cells; and (7) grades II to IV acute graft-versus-host disease (GVHD). A risk model for progression was generated, defined as low (0-1 risk factors, 6% incidence), intermediate (2-3 risk factors, 27% incidence), or high risk (≥ 3 risk factors, 72% incidence [P < .001]). These findings may help in the interpretation and design of future studies on secondary prophylaxis of IA after an allo-HSCT.Keywords
This publication has 36 references indexed in Scilit:
- Galactomannan and Computed Tomography-Based Preemptive Antifungal Therapy in Neutropenic Patients at High Risk for Invasive Fungal Infection: A Prospective Feasibility StudyClinical Infectious Diseases, 2005
- Galactomannan Does Not Precede Major Signs on a Pulmonary Computerized Tomographic Scan Suggestive of Invasive Aspergillosis in Patients with Hematological MalignanciesClinical Infectious Diseases, 2005
- Reproducibility of Low Galactomannan Enzyme Immunoassay Index Values Tested in Multiple LaboratoriesJournal of Clinical Microbiology, 2005
- Pulmonary Complications in Adult Blood and Marrow Transplant RecipientsChest, 2005
- Multicenter Clinical Evaluation of the (1->3) -D-Glucan Assay as an Aid to Diagnosis of Fungal Infections in HumansClinical Infectious Diseases, 2005
- Evaluation of Serum Sandwich Enzyme-Linked Immunosorbent Assay for Circulating Galactomannan during Caspofungin Therapy: Results from the Caspofungin Invasive Aspergillosis StudyClinical Infectious Diseases, 2005
- Reduced-Intensity Conditioning Allogeneic Blood Stem Cell Transplantation with Fludarabine and Oral Busulfan with or without Pharmacokinetically Targeted Busulfan Dosing in Patients with Myeloid Leukemia Ineligible for Conventional ConditioningTransplantation and Cellular Therapy, 2005
- Antifungal Therapy Decreases Sensitivity of theAspergillus Galactomannan Enzyme ImmunoassayClinical Infectious Diseases, 2005
- Invasive Aspergillosis Disease Spectrum, Treatment Practices, and OutcomesMedicine, 2000
- Impact of previous aspergillosis on the outcome of bone marrow transplantation.Clinical Infectious Diseases, 1998