Invasive fungal disease in patients undergoing umbilical cord blood transplantation after myeloablative conditioning regimen

• Published in: European journal of haematology Vol. 102; no. 4; pp. 331 - 340
• Main Authors: Montoro, Juan, Sanz, Jaime, Lorenzo, José I., Montesinos, Pau, Rodríguez‐Veiga, Rebeca, Salavert, Miguel, González, Eva, Guerreiro, Manuel, Carretero, Carlos, Balaguer, Aitana, Gómez, Inés, Solves, Pilar, Sanz, Guillermo F., Sanz, Miguel A., Piñana, José L.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01.04.2019
• Subjects: Aspergillosis; Candidemia; Cord blood; Fungal diseases; graft‐versus‐host disease; infections; invasive aspergillosis; invasive candidiasis; invasive fungal disease; mold infections; Multivariate analysis; Risk factors; Stem cells; Transplantation; Transplants & implants; Umbilical cord; umbilical cord blood transplantation; invasive aspergillosis; invasive fungal disease; umbilical cord blood transplantation; mold infections; infections; invasive candidiasis; graft-versus-host disease
• ISSN: 0902-4441; 1600-0609; 1600-0609
• DOI: 10.1111/ejh.13202

Objective Characteristics and risk factors (RFs) of invasive fungal disease (IFD) have been little studied in the setting of umbilical cord blood transplantation (UCBT). Method We retrospectively included 205 single‐unit myeloablative UCBT recipients with a median follow‐up of 64 months. Results Fifty‐six episodes of IFD were observed in 48 patients (23%) at a median time of 123 days after stem cell infusion. Invasive mold disease (IMD) occurred in 42 cases, 38 of them (90%) caused by invasive aspergillosis whereas invasive yeast disease (IYD) occurred in 14 cases, most of them due to candidemia (n = 12, 86%). The 5‐year cumulative incidence of IFD, IMDs, and IYDs was 24% 19%, and 7%, respectively. In multivariate analysis, three RFs for IMDs were identified: age >30 years (HR 3.5, P = 0.017), acute grade II‐IV graft‐versus‐host disease (HR 2.3, P = 0.011), and ≥1 previous transplant (HR 3.1, P = 0.012). The probability of IMDs was 2.5%, 14%, and 33% for recipients with none, 1, or 2‐3 RFs, respectively (P < 0.001). Among IFD, IMDs had a negative effect on non‐relapse mortality in multivariate analysis (HR 1.6, P = 0.039). IMDs showed a negative impact on overall survival (HR 1.59, P = 0.018). Conclusion Invasive mold disease were very common and serious complication after UCBT.