Incidence and Outcome of Invasive Fungal Diseases after Allogeneic Stem Cell Transplantation: A Prospective Study of the Gruppo Italiano Trapianto Midollo Osseo (GITMO)

Incidence and Outcome of Invasive Fungal Diseases after Allogeneic Stem Cell Transplantation: A Prospective Study of the Gruppo Italiano Trapianto Midollo Osseo (GITMO)

Transplantation and Cellular Therapy, March 2014

24631738

Corrado Girmenia, Anna Maria Raiola, Alfonso Piciocchi, Alessandra Algarotti, Marta Stanzani, Laura Cudillo, Clara Pecoraro, Stefano Guidi, Anna Paola Iori, Barbara Montante, Patrizia Chiusolo, Edoardo Lanino, Angelo Michele Carella, Elisa Zucchetti, Benedetto Bruno, Giuseppe Irrera, Francesca Patriarca, Donatella Baronciani, Maurizio Musso, Arcangelo Prete, Antonio Maria Risitano, Domenico Russo, Nicola Mordini, Domenico Pastore, Adriana Vacca, Francesco Onida, Sadia Falcioni, Giovanni Pisapia, Giuseppe Milone, Daniele Vallisa, Attilio Olivieri, Alessandro Bonini, Elio Castagnola, Simona Sica, Ignazio Majolino, Alberto Bosi, Alessandro Busca, William Arcese, Giuseppe Bandini, Andrea Bacigalupo, Alessandro Rambaldi, Anna Locasciulli

Epidemiologic investigation of invasive fungal diseases (IFDs) in allogeneic hematopoietic stem cell transplantation (allo-HSCT) may be useful to identify subpopulations who might benefit from targeted treatment strategies. The Gruppo Italiano Trapianto Midollo Osseo (GITMO) prospectively registered data on 1858 consecutive patients undergoing allo-HSCT between 2008 and 2010. Logistic regression analysis was performed to identify risk factors for proven/probable IFD (PP-IFD) during the early (days 0 to 40), late (days 41 to 100), and very late (days 101 to 365) phases after allo-HSCT and to evaluate the impact of PP-IFDs on 1-year overall survival. The cumulative incidence of PP-IFDs was 5.1% at 40 days, 6.7% at 100 days, and 8.8% at 12 months post-transplantation. Multivariate analysis identified the following variables as associated with PP-IFDs: transplant from an unrelated volunteer donor or cord blood, active acute leukemia at the time of transplantation, and an IFD before transplantation in the early phase; transplant from an unrelated volunteer donor or cord blood and grade II-IV acute graft-versus-host disease (GVHD) in the late phase; and grade II-IV acute GVHD and extensive chronic GVHD in the very late phase. The risk for PP-IFD was significantly higher when acute GVHD was followed by chronic GVHD and when acute GVHD occurred in patients undergoing transplantation with grafts from other than matched related donors. The presence of PP-IFD was an independent factor in long-term survival (hazard ratio, 2.90; 95% confidence interval, 2.32 to 3.62; P < .0001). Our findings indicate that tailored prevention strategies may be useful in subpopulations at differing levels of risk for PP-IFDs.