Invasive fungal diseases in patients after allogeneic hematopoietic stem cell transplantation

Background: The aim of the study was to determine the risk factors and incidence of invasive fungal diseases (IFD) in patients after allo-HSCT.Materials and patients: In our department 221 allo-HSCTs from related, unrelated and haploidentical donors were performed between October 2000 and June 2008. In the study were enrolled 131 patients younger than 21 and 90 patients older than 21 years old after allo-HSCT. In 87 (37%) patients allo-HSCT was conducted in non-remission.Results: The incidence of IFD after allo-HSCT remains high. Depending on donor characteristics (HLA-matched related, unrelated or haploidentical donor) it is 28%, 35%, and 38% respectively. Looking at age it is 32% for patients ≤21 years, and 27% for patients >21 years. In the RIC regimen group IFD was diagnosed in 34% of younger (≤21 years) patients and 31% of older (>21 years); and for the MC group it amounted to 32% for younger (p>0.05) and 17% for elder age groups (p<0.05). Neither the rate of IFD in both age groups, the source of HSC and/or rate of post-transplant engraftment were found to independently exert influence on the incidence of IFD following allo-SCT. In multifactor analysis was noticed correlation between HSC sources and age.IFD incidence was 1.8-fold higher in elder relapsed patients after related allo-HSCT with RIC (p<0.05). Contrariwise, in this group the incidence of IFD was low in patients that underwent HSCT in remission and received PBSC (p<0.05). The influence of transplant type was also noticed in the younger (≤21 years) group: the probability of IFD development was much higher in relapsed patients after BM allo-HSCT with RIC (p<0.05). It was noticed that the disease stage, grade I–IV mucositis (p<0.05), and extensive cGVHD (p<0.05) were the most prominent risk factors for IFD development. When these factors are present no difference was seen in groups with different conditioning regimens and HSC sources. In patients >21 years IFD incidence increased by inclusion of ATG in the conditioning regimen (p<0.05). Conclusions: The main risk factors that influence the incidence of IFD after allo-HSCT in all age groups are the stage of the disease, mucositis development, and extensive form of cGVHD. After diagnosis of IFD 12-weeks OS is 50%. IFD impairs 5-years OS after allo-HSCT.