Objective: To approach the clinical characteristic and risk factors affecting the incidence and outcome of post-transplantation invasive fungal infection (IFI) in patients with malignant hematologic disease and undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT).
Methods: The incidence and outcome of IFI after transplantation in 193 cases of recipients underwent allo-HSCT in our single center were assessed retrospectively. Some potential influential factors for that of IFI were analyzed by methods of bivariate correlate analysis and binary logistic regression analysis, including the source of donor and stem cell, human leukocyte antigen matched, white blood cell engraftment, the history and states of IFI before transplantation, prophylaxis schema for GVHD, acute and chronic GVHD.
Results: The 2-year cumulative incidence of post-transplantation IFI was 34.0% +/- 4.0%. The incidences of breakthrough IFI at primary and secondary prophylaxis were 3.8% and 21.1%, respectively (P = 0.000). 84.2% patients with IFI occurred within half of years after transplantation. In fungus that can be measured, molds and yeasts accounted for 68.1% and 27.7%, respectively. Infective sites in pulmonary or not accounted for were 67.3% and 27.7%, respectively. The total effective rate of IFI was 67.3%, complete response rate was 44.2%. Furthermore, there was no statistically significant difference in the therapeutic effect of antifungal agents between patients with a history of IFI and those without before transplantation. IFI-related mortality was 38.5%. Muti-variate analysis showed acute GVHD was an important factor affecting the incidence and outcome of IFI.
Conclusion: Pulmonary mold infection was the most common IFI after allo-HSCT. patients with a history of IFI did not seem to be an contraindication for allo-HSCT. Acute GVHD was a significant risk factor for the incidence and outcome of IFI.