Hematopoietic SCT in patients with a history of invasive fungal infection

Abstract

Earlier invasive fungal infections (IFI) put recipients of hematopoietic SCT (HSCT) at a high risk of IFI-related mortality. We retrospectively assessed the feasibility of HSCT for patients with a history of IFI and the efficacy of secondary prophylaxis. From January 2001 to December 2007, 49 patients with a history of IFI underwent HSCT and most of them received broadspectrum antifungal agents as secondary prophylaxis. After a median follow-up of 355 days (15-967), nine patients experienced failure of IFI prophylaxis, including three cases of IFI-related death, leading to a 2-year cumulative incidence of 18.4 and 6.1%, respectively. Four risk factors for the failure of prophylaxis were found, namely time interval from the diagnosis of IFI to transplantation, residual diseases before transplantation, infection with CMV and use of corticosteroid for the treatment of GVHD. A similar outcome can be achieved in recipients of Auto-and Auto-HSCT. Despite a higher risk of post-transplant progression, residual features of IFI did not affect the overall outcome of HSCT. In conclusion, a history of IFI and residual features are not contraindications to HSCT and secondary prophylaxis by broad-spectrum antifungal agents can protect patients from relapse or progression of an earlier infection.

Excretion of the novel polyomaviruses KI and WU in the stool of patients with hematological disorders

“…Infections in transplanted patients are related broadly to the kinetics of immune reconstitution and are due frequently to reactivation of latent viruses such as CMV, Adv, BKV, and JCV polyomaviruses [Priftakis et al, 2003;Echavarrıa, 2008;Widmann et al, 2008], although other infections (fungal and bacterial) can occur [Yuen et al, 1998;Zhang et al, 2009]. Numerous papers are available in literature on the pathogenic role of these viruses in immunodepressed patients.…”

The impact of prior invasive mold infections in leukemia patients who undergo allo-SCT in the era of triazole-based secondary prophylaxis

“…1,3,10 Unfortunately, in our analysis, the small number of cases and recurrent IMIs limited our ability to determine the relative importance of these variables. Notably, the majority of our patients had completed more than 4 weeks of antifungal treatment, and was estimated to have PR or CR before undergoing HSCT.…”

Risk factors for fungal pulmonary infections in hematopoietic stem cell transplantation recipients: the role of iron overload

“…Although active fungal disease is reported not to be a contraindication to HSCT, the risk of IFIs may be expected to be higher among patients who had a history of fungal infections. 41 Recently, Zhang et al 42 reported an incidence of 18.4% of IFIs among HSCT patients with a history of previous IFI. An intriguing finding of the present study is the lack of an association between acute GVHD and FPIs, which should be validated with a larger sample size.…”