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Journal of Zhejiang University SCIENCE B

ISSN 1673-1581(Print), 1862-1783(Online), Monthly

Invasive fungal infection in allogeneic hematopoietic stem cell transplant recipients: single center experiences of 12 years

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).

Key words: Invasive fungal infection, Allogeneic hematopoietic stem cell transplantation, Incidence, Risk factors

Chinese Summary  <25> 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

目的:回顾性分析了浙江大学医学院附属第一医院骨髓移植中心1998年至2009年接受造血干细胞移植(HSCT)发生侵袭性真菌感染(IFI)的患者资料,评估HSCT后IFI发病情况、流行病学特征及危险因素,以期寻找病原菌特点及相关的危险因素,为制定更有针对性的预防治疗策略提供依据。
创新点:首次对本中心异基因HSCT后的IFI感染情况进行统计分析,研究年限长,样本量较大;另作为国内较成熟的移植中心之一,本中心的研究结果对国内异基因HSCT后IFI感染情况有较大的参考意义。
方法:对1998年11月至2009年12月在本移植中心接受异基因HSCT的408例患者进行观察分析,总结HSCT后IFI发病情况和病原菌分布,并采用多因素分析判断危险因素。
结论:本研究显示IFI与HSCT预后明显相关,HSCT后不同时期IFI病原菌分布及危险因素存在差异。临床应根据IFI病原学特点及HSCT后时间分布特点,采取不同的策略,更有针对性地用药及开始治疗,从而改善预后。

关键词组:侵袭性真菌感染;异基因造血干细胞移植;危险因素


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DOI:

10.1631/jzus.B1500005

CLC number:

R55

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On-line Access:

2015-09-05

Received:

2015-01-04

Revision Accepted:

2015-06-09

Crosschecked:

2015-08-17

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