Simone Cesaro1, Gloria Tridello1, Nicole Blijlevens2, Per Ljungman3, Charles Craddock4, Mauricette Michallet5, Alexander Martin6, John A Snowden7, Mohamad Mohty8, Johan Maertens9, Jacob Passweg10, Eefke Petersen11, Anne Nihtinen12, Cecilia Isaksson13, Noel Milpied14, Pierre-Simon Rohlich15, Eric Deconinck16, Charles Crawley17, Marie-Pierre Ledoux18, Jennifer Hoek19, Arnon Nagler20, Jan Styczynski21. 1. Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. 2. Department of Hematology, Radboud University-Nijmegen Medical Centre, The Netherlands. 3. Department of Hematology, Karolinska University Hospital, Stockholm, Sweden. 4. Center for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom. 5. Service d' Hematologie, Centre Hospitalier Lyon Sud, Pierre-Bénite, France. 6. Leicester Royal Infirmary, United Kingdom. 7. Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom. 8. Hospital Saint Antoine, University Pierre & Marie Curie, and INSERM UMRs, Paris, France. 9. University Hospital Gasthuisberg, Leuven, Belgium. 10. Department of Hematology, University Hospital, Basel, Switzerland. 11. University Medical Centre, Utrecht, The Netherlands. 12. HUCH Comprehensive Cancer Center, Helsinki, Finland. 13. Umea University Hospital, Sweden. 14. CHU Bordeaux, Pessac. 15. CHU Nice-Hôpital de l'Archet. 16. CHRU Besançon, Hematology, Inserm, France. 17. Addenbrookes Hospital, Cambridge, United Kingdom. 18. Hôpitaux Universitaires, Strasbourg, France. 19. EBMT Data Office, Leiden, The Netherlands. 20. ALWP Office, Hospital Saint Antoine, Paris, France. 21. Department of Pediatric Hematology Oncology, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland.
Abstract
Background: This study was performed to assess the incidence of and risk factors for Candida infection in the first 100 days after allogeneic hematopoietic stem cell transplantation (HSCT) and the impact on long-term survival. Methods: We performed an outcome analysis of 28542 acute leukemia patients who underwent HSCT from 2000 to 2012. There were 347 patients with candidemia by day 100 and 28195 without candidemia or any other type of Candida infection. Results: The incidence of candidemia by day 100 was 1.2% and occurred at a median of 22 days after HSCT. Higher 100-day nonrelapse mortality (NRM; hazards ratio [HR], 3.0, P < .0001) and lower 100-day overall survival (OS; HR, 2.5, P < .0001) were observed in patients with candidemia. The case fatality rate by day 100 in patients with candidemia was 22% (76/347). Factors associated with candidemia occurrence were female gender, bone marrow or cord blood stem cell source, T-cell depletion, use of total body irradiation, and acute graft vs host disease. Among the patients alive at day 100, the 5-year NRM and OS after a median follow-up of 5.6 years (95% confidence interval, 5.5 - 5.7) for patients with and without candidemia were 22.5% vs 13.5%, P < .0001 and 45.6% vs. 53.4%, P = .0003, respectively. In multivariate analysis, the occurrence of a candidemia episode by day 100 was an independent risk factor for higher NRM (HR, 1.7, P = .001) and lower OS (HR, 1.4, P = .001). Conclusions: The early occurrence of candidemia after HSCT is still associated with higher NRM and lower short- and-long-term OS.
Background: This study was performed to assess the incidence of and risk factors for Candida infection in the first 100 days after allogeneic hematopoietic stem cell transplantation (HSCT) and the impact on long-term survival. Methods: We performed an outcome analysis of 28542 acute leukemiapatients who underwent HSCT from 2000 to 2012. There were 347 patients with candidemia by day 100 and 28195 without candidemia or any other type of Candida infection. Results: The incidence of candidemia by day 100 was 1.2% and occurred at a median of 22 days after HSCT. Higher 100-day nonrelapse mortality (NRM; hazards ratio [HR], 3.0, P < .0001) and lower 100-day overall survival (OS; HR, 2.5, P < .0001) were observed in patients with candidemia. The case fatality rate by day 100 in patients with candidemia was 22% (76/347). Factors associated with candidemia occurrence were female gender, bone marrow or cord blood stem cell source, T-cell depletion, use of total body irradiation, and acute graft vs host disease. Among the patients alive at day 100, the 5-year NRM and OS after a median follow-up of 5.6 years (95% confidence interval, 5.5 - 5.7) for patients with and without candidemia were 22.5% vs 13.5%, P < .0001 and 45.6% vs. 53.4%, P = .0003, respectively. In multivariate analysis, the occurrence of a candidemia episode by day 100 was an independent risk factor for higher NRM (HR, 1.7, P = .001) and lower OS (HR, 1.4, P = .001). Conclusions: The early occurrence of candidemia after HSCT is still associated with higher NRM and lower short- and-long-term OS.
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