Invasive fungal disease is associated with chronic graft-versus-host disease after allogeneic hematopoietic stem cell transplant: a single center, retrospective study

Infection. 2019 Apr;47(2):275-284. doi: 10.1007/s15010-018-01265-3. Epub 2019 Feb 7.

Abstract

Background: Invasive fungal disease (IFD) and graft-versus-host disease (GVHD) are major causes of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, the impacts of IFD on chronic GVHD remain unknown.

Methods: We conducted a retrospective study of 510 patients with hematologic malignancy undergoing allo-HSCT to explore the effects of IFD on chronic GVHD.

Results: The 2-year cumulative incidences of overall (limited and extensive) and extensive chronic GVHD post-transplantation were higher in patients with IFD compared with those without IFD (69.5% ± 4.2% versus 32.9% ± 2.4%, P < .001; 43.0% ± 5.2% versus 6.6% ± 1.4%, P < .001, respectively). Moreover, the patients with IFD had higher 5-year transplant-related mortality, lower 5-year overall survival and lower 5-year disease-free survival (29.8% ± 4.3% versus 9.8% ± 1.6%, P < .001; 50.5% ± 4.9% versus 71.3% ± 2.4%, P < .001 and 48.8% ± 4.7% versus 71.8% ± 2.3%, P < .001, respectively). Multivariable analyses demonstrated that IFD increased the risk of chronic GVHD.

Conclusion: Our results suggest that IFD significantly contributes to the development of chronic GVHD after allo-HSCT.

Keywords: Allogeneic hematopoietic stem cell transplantation; Graft-versus-host disease; Invasive fungal disease.

MeSH terms

  • Adolescent
  • Adult
  • China / epidemiology
  • Chronic Disease / epidemiology
  • Cohort Studies
  • Female
  • Graft vs Host Disease / epidemiology*
  • Graft vs Host Disease / immunology
  • Graft vs Host Disease / mortality
  • Graft vs Host Disease / physiopathology
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Humans
  • Incidence
  • Invasive Fungal Infections / immunology
  • Invasive Fungal Infections / microbiology
  • Invasive Fungal Infections / mortality*
  • Invasive Fungal Infections / physiopathology
  • Male
  • Middle Aged
  • Postoperative Complications / epidemiology*
  • Postoperative Complications / microbiology
  • Postoperative Complications / mortality
  • Postoperative Complications / physiopathology
  • Retrospective Studies
  • Transplantation, Homologous / adverse effects
  • Young Adult