Risks and outcomes of invasive fungal infections in pediatric allogeneic hematopoietic stem cell transplant recipients receiving fluconazole prophylaxis: a multicenter cohort study by the Turkish Pediatric Bone Marrow Transplantation Study Group
Makaleler > Tam Makale · 2018
Yazarlar: Volkan Hazar, Gulsun Tezcan Karasu, Vedat Uygun, Gulyuz Ozturk, Suar Caki Kilic, Alphan Kupesiz, Hayriye Daloglu, Serap AKSOYLAR, Didem Atay, Elif Unal Ince, Musa Karakukcu, Namik Ozbek, Funda Tayfun, Savaş KANSOY, Emel Ozyurek, Arzu Akcay, Orhan Gursel, Sule Haskologlu, Zuhre Kaya, Sebnem Yilmaz, Atila Tanyeli, Akif Yesilipek
MEDICAL MYCOLOGY, SCI Expanded İndekslerine Giren Dergi, Uluslararası, 2018, cilt 57, ss 161-170
DOI: 10.1093/mmy/myy015
Özet
Invasive fungal infections (IFIs) are a major cause of infection-related morbidity and mortality in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). Data from pediatric settings are scarce. To determine the incidence, risk factors and outcomes of IFIs in a 180-day period post-transplantation, 408 pediatric patients who underwent allogeneic HSCT were retrospectively analyzed. The study included only proven and probable IFIs. The cumulative incidences of IFI were 2.7%, 5.0%, and 6.5% at 30, 100, and 180 days post-transplantation, respectively. According to the multivariate analysis, the factors associated with increased IFI risk in the 180-day period post-HSCT were previous HSCT history (hazard ratio [HR], 4.57; 95% confidence interval [CI] 1.42-14.71; P =.011), use of anti-thymocyte globulin (ATG) (HR, 2.94; 95% CI 1.27-6.80; P =.012), grade III-IV acute graft-versus-host-disease (GVHD) (HR, 2.91; 95% CI 1.24-6.80; P =.014) and late or no lymphocyte engraftment (HR, 2.71; 95% CI 1.30-5.62; P =.007). CMV reactivation was marginally associated with an increased risk of IFI development (HR, 1.91; 95% CI 0.97-3.74; P =.063). IFI-related mortality was 1.5%, and case fatality rate was 27.0%. The close monitoring of IFIs in pediatric patients with severe acute GVHD who receive ATG during conditioning is critical to reduce morbidity and mortality after allogeneic HSCT, particularly among those with prior HSCT and no or late lymphocyte engraftment.