Department of Hematology, Hospital Universitari i Politècnic La Fe, València, Spain.
CIBERONC, Instituto Carlos III, Madrid, Spain.
Mycoses. 2019 May;62(5):418-427. doi: 10.1111/myc.12891. Epub 2019 Mar 8.
Recently, we reported a simple prognostic score for post-engraftment invasive fungal disease (IFD) obtained in 404 adult allogeneic hematopoietic stem cell transplant (alloSCT) (training cohort).
We aim to validate this score in an external cohort assessing the 1-year cumulative incidence (CI) of post-engraftment IFD. Additionally, we analyse the type of IFD and incidence of IFD according to type of prophylaxis.
PATIENTS/METHODS: We included 465 consecutive adult recipients surviving >40 days who engrafted and were discharged without prior IFD (median age 45 years, range, 14-69).
Patients classified as low-risk, 139; intermediate-risk, 162; and high-risk, 164 (35% vs 27% in the training cohort, P = 0.03). The CI of probable/proven IFD in the validation cohort was 8% vs 11% in the training cohort (P = 0.006). The only voriconazole prophylaxis used in the training cohort was 100 mg/12 h, 65% vs 27% in the validation cohort, but 38% received 200 mg/12 h. Thus, the validation cohort showed a lower CI of IFD (P = 0.009). The post-engraftment IFD score was validated, showing a CI of IFD for low-, intermediate- and high-risk of 3%, 6% and 14%, respectively (P < 0.001).
To our knowledge, this is the first prognostic index to predict the occurrence of post-engraftment IFD after alloSCT that has been validated in an external cohort.
最近，我们报道了一个在 404 例成人异基因造血干细胞移植（alloSCT）（训练队列）中获得的用于移植后侵袭性真菌感染（IFD）的简单预后评分。
我们旨在通过评估移植后 IFD 的 1 年累积发生率（CI）来验证该评分在外部队列中的有效性。此外，我们还根据预防类型分析了 IFD 的类型和 IFD 的发生率。
患者/方法：我们纳入了 465 例连续接受异基因造血干细胞移植且移植后>40 天存活并在无先前 IFD 的情况下出院的成年受者（中位年龄 45 岁，范围 14-69 岁）。
患者被分类为低危 139 例、中危 162 例和高危 164 例（分别占 35%和 27%，与训练队列相比，P=0.03）。验证队列中可能/确诊 IFD 的 CI 为 8%，而训练队列为 11%（P=0.006）。在训练队列中，仅使用伏立康唑 100mg/12h 预防，占 65%，而在验证队列中，仅占 27%，但有 38%的患者使用 200mg/12h 预防。因此，验证队列中 IFD 的 CI 较低（P=0.009）。移植后 IFD 评分得到验证，低、中、高危的 IFD CI 分别为 3%、6%和 14%（P<0.001）。
据我们所知，这是第一个在外部队列中得到验证的预测 alloSCT 后移植后 IFD 发生的预后指数。
