BACKGROUND: Invasive fungal infections (IFIs) are a major cause of mortality among allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients. Thanks to the widespread use of secondary antifungal prophylaxis (SAP), a history of IFI is not an absolute contraindication to allo-HSCT. However, IFI recurrence remains a risk factor for transplant-related mortality. METHODS: To evaluate the risk factors for IFI recurrence in allo-HSCT patients receiving SAP, we performed a retrospective analysis of 90 individuals treated at our hospital. SAP antifungal agents included fluconazole (n = 28), voriconazole (n = 25), itraconazole (n = 23), caspofungin (n = 7), and micafungin (n = 7). RESULTS: By day +100, recurrent IFI had occurred in 23 (25.5%) patients. Our multivariate analysis identified 4 factors significantly associated with a risk of IFI recurrence within 100 days of allo-HSCT: duration of neutropenia >18 days, presence of severe acute graft-versus-host disease (aGVHD), <70-day interval between previous infection and transplantation, and use of a narrow-spectrum SAP agent (P = 0.008, 0.010, 0.041, and 0.001, respectively). Of the 87 patients who remained in the study for the duration of the follow-up period (median length: 551 days), 26 (29.9%) died; only 7 (8.0%) of these deaths resulted from a severe fungal infection. CONCLUSION: These results suggest that transplantation outcome can be improved by adequate antifungal treatment before transplantation, better prevention of, and therapy for, severe aGVHD, use of granulocyte colony-stimulating factor to reduce the duration of neutropenia, and use of broad-spectrum prophylaxis agents.
BACKGROUND: Invasive fungal infections (IFIs) are a major cause of mortality among allogeneic hematopoietic stem cell transplantation (allo-HSCT) patients. Thanks to the widespread use of secondary antifungal prophylaxis (SAP), a history of IFI is not an absolute contraindication to allo-HSCT. However, IFI recurrence remains a risk factor for transplant-related mortality. METHODS: To evaluate the risk factors for IFI recurrence in allo-HSCT patients receiving SAP, we performed a retrospective analysis of 90 individuals treated at our hospital. SAP antifungal agents included fluconazole (n = 28), voriconazole (n = 25), itraconazole (n = 23), caspofungin (n = 7), and micafungin (n = 7). RESULTS: By day +100, recurrent IFI had occurred in 23 (25.5%) patients. Our multivariate analysis identified 4 factors significantly associated with a risk of IFI recurrence within 100 days of allo-HSCT: duration of neutropenia >18 days, presence of severe acute graft-versus-host disease (aGVHD), <70-day interval between previous infection and transplantation, and use of a narrow-spectrum SAP agent (P = 0.008, 0.010, 0.041, and 0.001, respectively). Of the 87 patients who remained in the study for the duration of the follow-up period (median length: 551 days), 26 (29.9%) died; only 7 (8.0%) of these deaths resulted from a severe fungal infection. CONCLUSION: These results suggest that transplantation outcome can be improved by adequate antifungal treatment before transplantation, better prevention of, and therapy for, severe aGVHD, use of granulocyte colony-stimulating factor to reduce the duration of neutropenia, and use of broad-spectrum prophylaxis agents.