Epidemiology of invasive mold infections in allogeneic stem cell transplant recipients: Biological risk factors for infection according to time after transplantation

被引:287
作者
Garcia-Vidal, Carol [1 ,4 ]
Upton, Arlo [1 ]
Kirby, Katharine A. [1 ]
Marr, Kieren A. [1 ,2 ,3 ]
机构
[1] Fred Hutchinson Canc Res Ctr, Seattle, WA 98104 USA
[2] Univ Washington, Seattle, WA 98195 USA
[3] Oregon Hlth & Sci Univ, Portland, OR 97201 USA
[4] Hosp Univ Bellvitge, Barcelona, Spain
基金
美国国家卫生研究院;
关键词
D O I
10.1086/591969
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. Invasive mold infections (IMIs) are common in individuals who have undergone hematopoietic stem cell transplantation (HSCT). We sought to determine clinical and biological risk factors for different IMIs during each period (early and late) after allogeneic HSCT. Methods. Cases of proven and probable IMI diagnosed in HSCT recipients at the Fred Hutchinson Cancer Research Center (Seattle, WA) from 1 January 1998 through 31 December 2002 were included. Survival was estimated with Kaplan-Meier curves, and Cox regression models were used for multivariable analyses. Results. During the study period, 1248 patients underwent allogeneic HSCT; 163 (13.1%) received a diagnosis of probable or proven IMI. The majority of cases were caused by Aspergillus species (88%). The incidence of IMI caused by other molds remained low (<2%) over the 4-year study period. Risk factors for IMI early after HSCT and late after HSCT differed, with host variables (age) and transplant variables (human leukocyte antigen match) predominating as early risk factors and other clinical complications (graft-versus-host disease and cytomegalovirus disease) predominating later. Biological risk factors that were important during all periods included multiple cytopenias (neutropenia, lymphopenia, and monocytopenia) and iron overload. Conclusions. Risk factors for invasive aspergillosis after allogeneic HSCT are multifactorial and differ according to timing after HSCT. Increased attention should be placed on understanding the immunopathogenesis of fungal disease after HSCT.
引用
收藏
页码:1041 / 1050
页数:10
相关论文
共 32 条
[1]   Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: An international consensus [J].
Ascioglu, S ;
Rex, JH ;
de Pauw, B ;
Bennett, JE ;
Bille, J ;
Crokaert, F ;
Denning, DW ;
Donnelly, JP ;
Edwards, JE ;
Erjavec, Z ;
Fiere, D ;
Lortholary, O ;
Maertens, J ;
Meis, JF ;
Patterson, TF ;
Ritter, J ;
Selleslag, D ;
Shah, PM ;
Stevens, DA ;
Walsh, TJ .
CLINICAL INFECTIOUS DISEASES, 2002, 34 (01) :7-14
[2]   Generation of highly purified and functionally active human TH1 cells against Aspergillus fumigatus [J].
Beck, O ;
Topp, MS ;
Koehl, U ;
Roilides, E ;
Simitsopoulou, M ;
Hanisch, M ;
Sarfati, J ;
Latgé, JP ;
Klingebiel, T ;
Einsele, H ;
Lehrnbecher, T .
BLOOD, 2006, 107 (06) :2562-2569
[3]   Transplantation of bone marrow as compared with peripheral-blood cells from HLA-identical relatives in patients with hematologic cancers. [J].
Bensinger, WI ;
Martin, PJ ;
Storer, B ;
Clift, R ;
Forman, SJ ;
Negrin, R ;
Kashyap, A ;
Flowers, MED ;
Lilleby, K ;
Chauncey, TR ;
Storb, R ;
Appelbaum, FR ;
Rowley, S ;
Heimfeld, S ;
Blume, K .
NEW ENGLAND JOURNAL OF MEDICINE, 2001, 344 (03) :175-181
[4]  
BOCHUD P, 2006, 46 INT C ANT AG CHEM
[5]  
Boeckh Michael, 2003, Herpes, V10, P12
[6]  
BRISSOT P, 1981, GASTROENTEROLOGY, V80, P557
[7]   Regulation by granulocyte-macrophage colony-stimulating factor and/or steroids given in vivo of proinflammatory cytokine and chemokine production by bronchoalveolar macrophages in response to Aspergillus conidia [J].
Brummer, E ;
Kamberi, M ;
Stevens, DA .
JOURNAL OF INFECTIOUS DISEASES, 2003, 187 (04) :705-709
[8]  
Buckner C D, 1991, Bone Marrow Transplant, V7 Suppl 2, P6
[9]   MARROW TRANSPLANTATION FOR CHRONIC MYELOID-LEUKEMIA - A RANDOMIZED STUDY COMPARING CYCLOPHOSPHAMIDE AND TOTAL-BODY IRRADIATION WITH BUSULFAN AND CYCLOPHOSPHAMIDE [J].
CLIFT, RA ;
BUCKNER, CD ;
THOMAS, ED ;
BENSINGER, WI ;
BOWDEN, R ;
BRYANT, E ;
DEEG, HJ ;
DONEY, KC ;
FISHER, LD ;
HANSEN, JA ;
MARTIN, P ;
MCDONALD, GB ;
SANDERS, JE ;
SCHOCH, G ;
SINGER, J ;
STORB, R ;
SULLIVAN, KM ;
WITHERSPOON, RP ;
APPELBAUM, FR .
BLOOD, 1994, 84 (06) :2036-2043
[10]   Risks and outcomes of invasive fungal infections in pediatric patients undergoing allogeneic hematopoietic cell transplantation [J].
Dvorak, CC ;
Steinbach, WJ ;
Brown, JMY ;
Agarwal, R .
BONE MARROW TRANSPLANTATION, 2005, 36 (07) :621-629