Post M J, Lass-Floerl C, Gastl G, Nachbaur D
Clinical Division of Hematology and Oncology, Innsbruck Medical University, Innsbruck, Austria.
Transpl Infect Dis. 2007 Sep;9(3):189-95. doi: 10.1111/j.1399-3062.2007.00219.x. Epub 2007 May 19.
Invasive fungal infections (IFIs) remain a major cause of infection-related morbidity and mortality following hematopoietic stem cell transplantation (HSCT).
We retrospectively analyzed the incidence of IFIs in 166 patients undergoing either allogeneic or autologous HSCT at our institution between January 2000 and December 2003.
Incidence of invasive aspergillosis (IA) and invasive candidiasis among allogeneic HSCT recipients was 23% (16-32%, 95% confidence interval [CI]) and 3% (1-9%, 95% CI), respectively. Duration of neutropenia and reduced-intensity conditioning were the only risk factors for IA in the multivariate model. Patients with IA had significantly reduced overall survival (8% versus 56%, P=0.01) due to higher transplant-related mortality (63% versus 31%, P=0.03). Following autologous HSCT, incidence of IA and invasive candidiasis was 8% (4-19%, 95% CI) and 2% (0.2-11%, 95% CI), respectively. Duration of neutropenia was the only risk factor for the development of IA following autologous HSCT. Overall survival of autologous HSCT recipients with IA was similar to that of patients without IA. Seventeen percent of autologous HSCT recipients were colonized with Candida species. Compared with non-colonized patients these patients had significantly reduced overall survival (72% versus 23%, P=0.004), due to increased treatment-related mortality (23% versus 9%, P=0.02).
Diagnosis of IA following allogeneic HSCT and Candida colonization in the setting of autologous HSCT defines patient populations with poor outcome but primarily not as a result of the fungal pathogen. Regarding the incidence of IA, duration of neutropenia is the main risk factor, and dose-reduced conditioning is an additional risk factor for the development of IA following allogeneic HSCT, probably owing to increased recipient age in this patient cohort, requiring further studies in this transplantation setting.
侵袭性真菌感染（IFI）仍是造血干细胞移植（HSCT）后感染相关发病和死亡的主要原因。
我们回顾性分析了2000年1月至2003年12月期间在我院接受异基因或自体HSCT的166例患者中IFI的发生率。
异基因HSCT受者中侵袭性曲霉病（IA）和侵袭性念珠菌病的发生率分别为23%（16%-32%，95%置信区间[CI]）和3%（1%-9%，95%CI）。在多变量模型中，中性粒细胞减少持续时间和减低强度预处理是IA的唯一危险因素。IA患者的总生存率显著降低（8%对56%，P=0.01），原因是移植相关死亡率较高（63%对31%，P=0.03）。自体HSCT后，IA和侵袭性念珠菌病的发生率分别为8%（4%-19%，95%CI）和2%（0.2%-11%，95%CI）。中性粒细胞减少持续时间是自体HSCT后发生IA的唯一危险因素。发生IA的自体HSCT受者的总生存率与未发生IA的患者相似。17%的自体HSCT受者念珠菌定植。与未定植患者相比，这些患者的总生存率显著降低（72%对23%，P=0.004），原因是治疗相关死亡率增加（23%对9%，P=0.02）。
异基因HSCT后IA的诊断以及自体HSCT情况下念珠菌定植确定了预后不良的患者群体，但主要不是由真菌病原体导致的。关于IA的发生率，中性粒细胞减少持续时间是主要危险因素，减低剂量预处理是异基因HSCT后发生IA的另一个危险因素，这可能是由于该患者队列中受者年龄增加所致，需要在这种移植情况下进行进一步研究。
