Invasive Mold Infections in Allogeneic Bone Marrow Transplant Recipients

Abstract

Invasive mold infections (IMIs) are an important cause of morbidity and mortality in patients who are undergoing bone marrow transplantation (BMT). To examine the epidemiology, risk factors, and outcome of IMIs in allogeneic BMT recipients, all cases of mold infection among 94 adult patients who underwent allogeneic BMT at this institution from 1 January 1997 through 31 December 1998 were reviewed retrospectively. Fifteen cases of IMI were identified; infection occurred a median of 102 days after BMT. Aspergillus species was the most common cause of disease, and species other than Aspergillus fumigatus were present in 53% of patients. By multivariate analysis, the variable associated with infection risk was systemic glucocorticosteroid use. Prophylactic antifungal therapy that was targeted to high-risk patients had little effect on disease incidence. These observations suggest that early identification of high-risk patients and better approaches to prevention should be explored, to reduce incidence and severity of disease in this population.

Invasive aspergillosis in patients with acute myeloid leukemia: a SEIFEM-2008 registry study

“…The remaining 12 patients received only targeted therapy (9%). The mean period between symptom onset and the start of empirical/preemptive treatment was 6 days (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. The difference between times to treatment was not significant (symptoms to empirical therapy, 1-18 days, mean 5 days; symptoms to pre-emptive therapy 1-19 days, mean 6 days).…”

“…[1][2][3] Although the severity and duration of neutropenia remain the major risk factors, the incidence of invasive aspergillosis has also increased after immunosuppressive therapy, such as alemtuzumab, infliximab or fludarabine-based chemotherapy. [4][5][6] The aspergillosis-attributable mortality rate (AMR) in AML is generally around 30-40%. In two consecutive multicenter studies we observed that the AMR decreased from 48% in 1987-1998 to 38.5% in 1999-2003.…”

Umbilical cord blood transplantation: Basic biology and clinical challenges to immune reconstitution

“…Immune reconstitution of T-and B-cell compartments following allogeneic transplantation may require as long as 12-24 months. The slow process of immune reconstitution together with post-engraftment immunosuppression creates an immunologic environment whereby the host is susceptible to opportunistic infections [54][55][56] as well as virally induced malignancies [57,58]. Recipients of unrelated donor or HLA non-identical transplants appear to have a higher rate of infectious complications than recipients of matched sibling allogeneic grafts [59][60][61].…”

Fungal Infections in Transplant and Oncology Patients

“…While cryptococcosis has been most commonly encountered in the HIV infected population [52], a multicenter study reporting 306 cases of cryptococcosis in non-HIV-infected patients found 0.7% of total cases occurred in HSCT recipients, 18% in SOT recipients, 9% in patients with hematologic malignancies, and 9% in patients with other malignancies [53]. Other U.S. studies have found similarly low rates of cryptococcal infection in the HSCT population [1,5,54], most likely owing to use of routine fluconazole prophylaxis following HSCT. The overall mortality for cryptococcosis in the non-HIV population was 30%, attributable mortality 12%, and hematologic malignancy as an underlying diagnosis was associated with decreased survival [53].…”

“…Unfortunately, the incidence of zygomycosis appears to be increasing in oncology centers and in HSCT populations specifically, possibly related to the use of voriconazole prophylaxis [35][36][37][38][39]. [1,5,54], most likely owing to use of routine fluconazole prophylaxis following HSCT. The overall mortality for cryptococcosis in the non-HIV population was 30%, attributable mortality 12%, and hematologic malignancy as an underlying diagnosis was associated with decreased survival [53].…”