Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for the Treatment of Hematological Diseases, Beijing, China.
Clin Microbiol Infect. 2013 Nov;19(11):1029-34. doi: 10.1111/1469-0691.12120. Epub 2013 Apr 8.
The aim of this study was to determine the incidence, clinical features and outcome of invasive fungal disease (IFD) after either unmanipulated haploidentical haematopoietic stem cell transplantation (HSCT) or human leukocyte antigen (HLA)-matched sibling HSCT. This was a head-to-head comparative study performed at a single centre. Patients were admitted between 2007 and 2010, and IFD was evaluated according to the revised EORTC/MSG criteria, with only proven and probable cases included. Of the 1042 consecutive patients enrolled, 390 received the HLA-matched HSCT and 652 received unmanipulated haploidentical HSCT. A total of 61 (5.8%) patients had IFD, including 15 proven cases and 46 probable cases. The incidence of IFD after unmanipulated haploidentical HSCT was significantly higher than that after HLA-matched transplantation (7.1% vs. 3.3%, respectively; p 0.007). IFD occurred later in patients receiving HLA-matched transplantation compared with patients receiving unmanipulated haploidentical HSCT (141.5 vs. 23 days, respectively; p 0.04). In multivariate analysis, acute graft-versus-host disease (GVHD) grades III to IV (HR = 2.214, 95% CI, 1.139-4.304; p 0.019), extensive chronic GVHD (HR = 2.413, 95% CI, 1.377-4.228; p 0.002) and haploidentical transplantation (HR = 2.648, 95% CI, 1.111-6.310; p 0.028) were identified as significant risk factors associated with IFD. The response to antifungal therapy and the IFD-attributable mortality were similar between the two types of transplantation. In conclusion, patients who received unmanipulated haploidentical HSCT had a higher risk of IFD than those patients who received HLA-matched HSCT, but the prognosis of IFD was not associated with the HLA type.
本研究旨在确定未经处理的单倍体相合造血干细胞移植（HSCT）或人类白细胞抗原（HLA）匹配的同胞 HSCT 后侵袭性真菌病（IFD）的发生率、临床特征和结局。这是在单一中心进行的头对头比较研究。患者于 2007 年至 2010 年期间入院，根据修订的 EORTC/MSG 标准评估 IFD，仅包括确诊和可能病例。在纳入的 1042 例连续患者中，390 例接受 HLA 匹配 HSCT，652 例接受未经处理的单倍体相合 HSCT。共有 61 例（5.8%）患者发生 IFD，包括 15 例确诊病例和 46 例可能病例。未经处理的单倍体相合 HSCT 后 IFD 的发生率明显高于 HLA 匹配移植（分别为 7.1%和 3.3%；p 0.007）。与接受 HLA 匹配移植的患者相比，接受未经处理的单倍体相合 HSCT 的患者 IFD 发生时间较晚（分别为 141.5 天和 23 天；p 0.04）。多因素分析显示，急性移植物抗宿主病（GVHD）III 至 IV 级（HR 2.214，95%CI，1.139-4.304；p 0.019）、广泛慢性 GVHD（HR 2.413，95%CI，1.377-4.228；p 0.002）和单倍体相合移植（HR 2.648，95%CI，1.111-6.310；p 0.028）是与 IFD 相关的显著危险因素。两种移植类型的抗真菌治疗反应和 IFD 相关死亡率相似。总之，接受未经处理的单倍体相合 HSCT 的患者发生 IFD 的风险高于接受 HLA 匹配 HSCT 的患者，但 IFD 的预后与 HLA 类型无关。
