Risk factors and impact of non-Aspergillus mold infections following allogeneic HCT: a CIBMTR infection and immune reconstitution analysis

• Type of Material: Article
• Authors: Marcie L. Riches, University of North Carolina; Steven Trifilio, Northwestern Memorial Hospital; Min Chen, Medical College of Wisconsin; Kwang Woo Ahn, Medical College of Wisconsin; Amelia Langston, Emory University; Hillard M. Lazarus, University Hospitals Case Medical Center; David I. Marks, University Hospitals Bristol NHS Trust; Rodrigo Martino, Hospital de la Santa Creu i Sant Pau; Richard T. Maziarz, Oregon Health and Science University; Genofeva A. Papanicolou, Memorial Sloan Kettering Cancer Center; John R. Wingard, University of Florida; Jo-Anne H. Young, University of Minnesota; Charles L. Bennett, University of South Carolina
• Language: English
• Date: 2016-02-01
• Publisher: Nature Publishing Group
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 Macmillan Publishers Limited. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1038/bmt.2015.263
• Title of Journal or Parent Work: Bone Marrow Transplantation
• ISSN: 0268-3369
• Volume: 51
• Issue: 2
• Start Page: 277
• End Page: 282
• Grant/Funding Information: The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two Grants N00014-13-1-0039 and N00014-14-1-0028 from the Office of Naval Research.; The CIBMTR is also supported by grants from several entities, listed in the Acknowledgments of the full article.
• Keywords: FLUCONAZOLE; REVISED DEFINITIONS; INVASIVE FUNGAL-INFECTIONS; Life Sciences & Biomedicine; Transplantation; Oncology; RETROSPECTIVE ANALYSIS; CELL TRANSPLANT RECIPIENTS; BONE-MARROW; Immunology; Biophysics; Science & Technology; GRAFT; VERSUS-HOST-DISEASE; RECEIVING VORICONAZOLE; Hematology; PROPHYLAXIS

Abstract

Risk factors for non-Aspergillus mold infection (NAMI) and the impact on transplant outcome are poorly assessed in the current era of antifungal agents. Outcomes of 124 patients receiving allogeneic hematopoietic cell transplantation (HCT) diagnosed with either mucormycosis (n=72) or fusariosis (n=52) between days 0 and 365 after HCT are described and compared with a control cohort (n=11 856). Patients with NAMI had more advanced disease (mucormycois: 25%, fusariosis: 23% and controls: 18%; P=0.004) and were more likely to have a Karnofsky performance status (KPS) <90% at HCT (mucormycosis: 42%, fusariosis: 38% and controls: 28%; P=0.048). The 1-year survival after HCT was 22% (15-29%) for cases and was significantly inferior compared with controls (65% (64-65%); P<0.001). Survival from infection was similarly dismal regardless of mucormycosis: 15% (8-25%) and fusariosis: 21% (11-33%). In multivariable analysis, NAMI was associated with a sixfold higher risk of death (P<0.0001) regardless of the site or timing of infection. Risk factors for mucormycosis include preceding acute GvHD, prior Aspergillus infection and older age. For fusariosis, increased risks including receipt of cord blood, prior CMV infection and transplant before May 2002. In conclusion, NAMI occurs infrequently, is associated with high mortality and appears with similar frequency in the current antifungal era.