Invasive fungal infections in recipients of allogeneic hematopoietic stem cell teens and young adults

Background. Despite of modern methods of diagnosing, prevention and treatment, invasive fungal disease (IFD) remains actual problem after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Data of IFD in adolescents and young adults (15–25 y.o.) after allo-HSCT are limited.

The aim of the study was to estimate of incidence, etiology, clinical signs and outcome of IFD in adolescents and young adults recipients
of allo-HSCT.

Materials and methods. In retrospective single center study from Jan 2013 to Dec 2014 were included 80 pts after first allo-HSCT in the clinic of Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg. EORTC/MSG 2008 criteria for IFD diagnosis were used. “Active IFD” means IFD diagnosed just before HSCT.

Results. Incidence of IFD before allo-HSCT was 18.8 % (n = 15): invasive aspregillosis (IA) (n = 11), invasive candidiasis (IC) (n = 3) and 1 patient had two IFD (IA + IC). Complete response to antifungal therapy was in 40 %, partial – 26.7 %, “active” IFD – 33.3 %. Secondary antifungal prophylaxis was made predominantly with voriconazole (80%). Patients without IFD before HSCT (n = 65) received primary antifungal prophylaxis predominantly with fluconazole (85 %). Cumulative incidence of IFD-events at 1 year after allo-HSCT was 15 %, at 2 years – 18.8 % including new cases of IFD (n = 14) and relapse of IFD (n = 1) after allo-HSCT with median day of oncet +43 (14–577). Incidence of IA was 15 %, IC – 2.5 %, pneumocystis pneumonia (PCP) – 1.25 %. IFD risk factors after allo-HSCT (< 0.05) were: age < 18 years, non-malignant diseases, active disease at the moment of HSCT, neutropenia grade IV more than 20 days, acute “graft-versus-host” disease. First-line therapy were: IA – voriconazole (58.3 %), IC – echinocandins (100 %), PP – co-trimoxazole (100 %). 12-weeks overall survival (OS) from day of IFD diagnosis after allo-HSCT was 93.3 %, IA – 91.7 %. All patients with IC and PCP alive. 100-days OS after allo-HSCT was 85 %, 2-year OS after allo-HSCT – 67.5 %. There was no difference in OS in patients with or without IFD before allo-HSCT.

Conclusion. Incidence of IFD in adolescents and young adults before allo-HSCT was 18.8 %. Only one patient relapsed with IA after allo-HSCT. Incidence of IFD after allo-HSCT (1 year) was 15 %. The main IFD was invasive aspergillosis. 12-weeks overall survival from IFD diagnosis after allo-HSCT was 93.3 %. IFD before and after allo-HSCT did not impair the outcome of the transplantation in adolescents and young adults.

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