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

Özyılmaz, Ezgi; Aydoğdu, Müge; Sucak, Gülsan Türköz; Aki, Şahika Zeynep; Özkurt, Zübeyde Nur; Yeğin, Zeynep Arzu; Köktürk, Nurdan

doi:10.1038/bmt.2009.383

Cited by 51 publications

(40 citation statements)

References 40 publications

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“…Multiple factors reported to be associated with the risk of IFI include donor type, conditioning regimens, prolonged neutropenia, GVHD, and highdose corticosteroids (Fukuda et al, 2003;Thursky et al, 2004;Ozyilmaz et al, 2010;Omer et al, 2013). According to our data, we found similar risk factors infecting IFI.…”

Section: Discussionsupporting

confidence: 72%

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Invasive fungal infection in allogeneic hematopoietic stem cell transplant recipients: single center experiences of 12 years

Shi

Pei

Luo

et al. 2015

J. Zhejiang Univ. Sci. B

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Abstract:Invasive fungal infection (IFI) is a growing cause of morbidity and mortality among patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT). We retrospectively reviewed the records of 408 patients undergoing allo-HSCTs during the period November 1998 to December 2009, analyzed the incidence and risk factors of IFI, and examined the impact of IFI on overall survival. A total of 92 (22.5%) episodes suffered proven or probable IFI (4 patients were proven, 88 patients were probable). Candida was the most common pathogen for early IFI, and mold was the most frequent causative organism for late IFI. A prior history of IFI, human leukocyte antigen (HLA) mismatch, long-time neutropenia, and acute graft-versus-host-disease (GVHD) were risk factors for early IFI. A prior history of IFI, corticosteroid therapy, cytomegalovirus (CMV) disease, and chronic GVHD were risk factors for late IFI. IFI-related mortality was 53.26%. The 12-year overall survival (OS) rate for IFI was significantly lower than that of patients without IFI (41.9% vs. 63.6%, P<0.01).

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Section: Discussionsupporting

confidence: 72%

“…Previously identified risk factors of IFI include donor type, GVHD, high-dose corticosteroids, increased ferritin levels, and so on (Fukuda et al, 2003;Thursky et al, 2004;Ozyilmaz et al, 2010;Omer et al, 2013). Epidemiology and risk factors of IFI differ due to the changes in antifungal prophylaxis and treatment in different regions.…”

Section: Introductionmentioning

confidence: 99%

Invasive fungal infection in allogeneic hematopoietic stem cell transplant recipients: single center experiences of 12 years

Shi

Pei

Luo

et al. 2015

J. Zhejiang Univ. Sci. B

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“…Complications related to IO might increase transplant-related mortality in allo-stem cell transplant patients [16]. These complications are posttransplant bacterial, fungal, and viral infections [17][18][19][20], mucositis [21], liver dysfunction [22], sinusoidal obstruction syndrome [23,24], and acute GVHD [25,26]. IO may also present an exacerbation of hepatic GVHD after alloHSCT [27], so a liver biopsy may be useful for differential diagnosis in these circumstances [28].…”

Section: Discussionmentioning

confidence: 98%

Efficacy and safety of oral deferasirox treatment in the posttransplant period for patients who have undergone allogeneic hematopoietic stem cell transplantation (alloHSCT)

et al. 2011

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Iron overload is considered to be associated with various complications in patients who undergo both allogeneic (allo) and autologous hematopoietic stem cell transplantation (HSCT). A total of 23 alloHSCT recipients who started deferasirox treatment due to hyperferritinemia (ferritin ≥1,000 ng/mL) were analyzed retrospectively. The demographic characteristics, data about deferasirox treatment, and history of phlebotomy were obtained from the patients' files. The reduction in posttreatment ferritin levels was found statistically significant compared with pretreatment ferritin levels in both def+phlebotomy and def+nonphlebotomy groups (p = 0.025 and 0.017, respectively). The liver enzymes, especially ALT and bilirubins, were significantly reduced after the treatment (p < 0.05). The deferasirox treatment reduced pretreatment ferritin levels below the level of 1,000 ng/mL in a median period of 94 days, and these data were found to be statistically significant (p < 0.05). The median treatment duration time with deferasirox was 94 days (72-122). The most common adverse effects were nausea and vomiting, which occurred in three of the patients (13%). In conclusion, our data suggest that oral deferasirox treatment may be used as a safe and effective alternative method for reducing iron overload in alloHSCT recipients, whether combined with or without phlebotomy.

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“…However, risk factors for IPFI are seldom investigated for patients with hematological malignancies, and most investigations that do occur were focused on patients receiving HSCT [8][9][10]. Some patients with hematological malignancies who have not received HSCT still develop IPFI, even they were not identified as having any of the risk factors.…”

Section: Abstract: Fungemia Mycoses/prevention and Control Epidemimentioning

confidence: 99%

Risk factors for invasive pulmonary fungal infection in patients with hematological malignancies not receiving hematopoietic stem cell transplant

Xy²,

Wu³

2012

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We investigated the incidence, pathogens and risk factors of invasive pulmonary fungal infection (IPFI) in patients with hematological malignancies who did not receive hematopoietic stem cell transplantation (HSCT). Of the 323 patients included, 106 had IPFI with confirmed diagnosis or clinical diagnosis, 111 had pulmonary bacterial infections, and 106 did not have pulmonary infections. The risk factors for IPFI were explored through logistic univariate and multivariate analysis. The incidence of IPFI in patients with hematological malignancies but without HSCT was 3.5%. The leading pathogen was Candida albicans which accounted for 50.7% of the infections, and the second one was Aspergillus which accounted for 37.3% of the infections. The main risk factors for these patients were days of hospitalization, history of IPFI, agranulocytosis, concomitant hypoproteinemia, number of antibiotics being used, concomitant bacterial sepsis, and age. Furthermore, Nystatin mouthwash was protective against IPFI. Among patients with hematological malignancies, IPFI causes the highest proportion of deaths. We have identified two important pathogens and several risk factors as well as one factor protective against IPFI. Awareness of risk factors and reduction of pathogens can decrease the incidence of IPFI. Key words: fungemia, mycoses/prevention and control, epidemiology, Nystatin, hematologic neoplasms/complicationsInvasive pulmonary fungal infections (IPFI) have high morbidity, high mortality, and a low detection rate in laboratories and in clinical practice. Though patients with IPFI deteriorate rapidly, clinical manifestations are usually nonspecific and frequently masked by underlying diseases. This leads to misdiagnosis of IPFI and delayed treatment. Together, these problems, along with the influence of underlying diseases, significantly increase mortality. When IPFI patients do not receive timely treatment, their mortality is as high as 30% to 80% [1].Risk factors for IPFI include long-term broad-spectrum antibiotic use, long-term glucocorticoid use, agranulocytosis, invasive procedures, long-term stay in intensive care unit, hematopoietic stem cell transplantation (HSCT), total parenteral nutrition, concomitant hypoproteinemia, diabetes, chronic obstructive pulmonary disease, cancer, and AIDS [1][2][3][4][5][6][7]. However, risk factors for IPFI are seldom investigated for patients with hematological malignancies, and most investigations that do occur were focused on patients receiving HSCT [8][9][10]. Some patients with hematological malignancies who have not received HSCT still develop IPFI, even they were not identified as having any of the risk factors. Therefore, it is imperative to investigate the risk factors for IPFI in these patients. The present study examines the overall incidence of IPFI and the pathogens involved in patients with hematological malignancies who did not receive HSCT. Controls were patients from the same group who developed pulmonary bacterial infection and patients without pulmonary infection....

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

Cited by 51 publications

References 40 publications

Invasive fungal infection in allogeneic hematopoietic stem cell transplant recipients: single center experiences of 12 years

Invasive fungal infection in allogeneic hematopoietic stem cell transplant recipients: single center experiences of 12 years

Efficacy and safety of oral deferasirox treatment in the posttransplant period for patients who have undergone allogeneic hematopoietic stem cell transplantation (alloHSCT)

Risk factors for invasive pulmonary fungal infection in patients with hematological malignancies not receiving hematopoietic stem cell transplant

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