Abstract: invasive fungal infection (IFI) is a growing cause of morbidity and mortality among patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT). We retrospectively reviewed the records of 408 patients undergoing allo-HSCTs during the period November 1998 to December 2009, analyzed the incidence and risk factors of IFI, and examined the impact of IFI on overall survival. A total of 92 (22.5%) episodes suffered proven or probable IFI (4 patients were proven, 88 patients were probable). Candida was the most common pathogen for early IFI, and mold was the most frequent causative organism for late IFI. A prior history of IFI, human leukocyte antigen (HLA) mismatch, long-time neutropenia, and acute graft-versus-host-disease (GVHD) were risk factors for early IFI. A prior history of IFI, corticosteroid therapy, cytomegalovirus (CMV) disease, and chronic GVHD were risk factors for late IFI. IFI-related mortality was 53.26%. The 12-year overall survival (OS) rate for IFI was significantly lower than that of patients without IFI (41.9% vs. 63.6%, P<0.01).

异基因造血干细胞移植术后侵袭性真菌感染的流行病学：单中心12年研究结果

[1]Ascioglu, S., Rex, J.H., de Pauw, B., et al., 2002. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin. Infect. Dis., 34(1):7-14.

[2]Bjorklund, A., Aschan, J., Labopin, M., et al., 2007. Risk factors for fatal infectious complications developing late after allogeneic stem cell transplantation. Bone Marrow Transplant., 40(11):1055-1062.

[3]Dagenais, T.R., Keller, N.P., 2009. Pathogenesis of Aspergillus fumigatus in invasive aspergillosis. Clin. Microbiol. Rev., 22(3):447-465.

[4]Fukuda, T., Boeckh, M., Carter, R.A., et al., 2003. Risks and outcomes of invasive fungal infections in recipients of allogeneic hematopoietic stem cell transplants after nonmyeloablative conditioning. Blood, 102(3):827-833.

[5]Garcia-Vidal, C., Upton, A., Kirby, K.A., et al., 2008. Epidemiology of invasive mold infections in allogeneic stem cell transplant recipients: biological risk factors for infection according to time after transplantation. Clin. Infect. Dis., 47(8):1041-1050.

[6]Gratwohl, A., Brand, R., Frassoni, F., et al., 2005. Cause of death after allogeneic haematopoietic stem cell transplantation (HSCT) in early leukaemias: an EBMT analysis of lethal infectious complications and changes over calendar time. Bone Marrow Transplant., 36(9):757-769.

[7]Hovi, L., Saarinen-Pihkala, U.M., Vettenranta, K., et al., 2000. Invasive fungal infection in pediatric BMT recipients: single center experience of 10 years. Bone Marrow Transplant., 26(9):999-1004.

[8]Jantunen, E., Ruutu, P., Niskanen, L., et al., 1997. Incidence and risk factors for invasive fungal infections in allogeneic BMT recipients. Bone Marrow Transplant., 19(8):801-808.

[9]Koldehoff, M., Zakrzewski, J.L., 2005. Modern management of respiratory failure due to pulmonary mycoses following allogeneic hematopoietic stem-cell transplantation. Am. J. Hematol., 79(2):158-163.

[10]Kontoyiannis, D.P., Marr, K.A., Park, B.J., et al., 2010. Prospective surveillance for invasive fungal infections in hematopoietic stem cell transplant recipients, 2001‒2006: overview of the Transplant Associated Infection Surveillance Network (TRANSNET) Database. Clin. Infect. Dis., 50(8):1091-1100.

[11]Lin, S.J., Schranz, J., Teutsch, S.M., 2001. Aspergillosis case-fatality rate: systematic review of the literature. Clin. Infect. Dis., 32(3):358-366.

[12]Marr, K.A., Carter, R.A., Boeckh, M., et al., 2002. Invasive aspergillosis in allogeneic stem cell transplant recipients: changes in epidemiology and risk factors. Blood, 100(13):4358-4366.

[13]Neofytos, D., Horn, D., Anaissie, E., et al., 2009. Epidemiology and outcome of invasive fungal infection in adult hematopoietic stem cell transplant recipients: analysis of Multicenter Prospective Antifungal Therapy (PATH) Allianee registry. Clin. Infect. Dis., 48(3):265-273.

[14]Omer, A.K., Ziakas, P.D., Anagnostou, T., et al., 2013. Risk factors for invasive fungal disease after allogeneic hematopoietic stem cell transplantation: a single center experience. Biol. Blood Marrow Transplant., 19(8):1190-1196.

[15]Ozyilmaz, E., Aydogdu, M., Sucak, G., et al., 2010. Risk factors for fungal pulmonary infections in hematopoietic stem cell transplantation recipients: the role of iron overload. Bone Marrow Transplant., 45(10):1528-1533.

[16]Post, M.J., Lass-Floerl, C., Gastl, G., et al., 2007. Invasive fungal infections in allogeneic and autologous stem cell transplant recipients: a single-center study of 166 transplanted patients. Transplant Infect. Dis., 9(3):189-195.

[17]Shi, J.M., Cai, Z., Huang, H., et al., 2009. Role of CT-guided percutaneous lung biopsy in diagnosis of pulmonary fungal infection in patients with hematologic diseases. Int. J. Hematol., 89(5):624-627.

[18]Thursky, K., Byrnes, G., Grigg, A., et al., 2004. Risk factors for post-engraftment invasive aspergillosis in allogeneic stem cell transplantation. Bone Marrow Transplant., 34(2):115-121.