Risk factors and attributable mortality of late aspergillosis after T-cell depleted hematopoietic stem cell transplantation Journal Article

  


Authors: Mihu, C. N.; King, E.; Yossepowitch, O.; Taur, Y.; Jakubowski, A.; Pamer, E.; Papanicolaou, G. A.
Article Title: Risk factors and attributable mortality of late aspergillosis after T-cell depleted hematopoietic stem cell transplantation
Abstract: Aim. Invasive aspergillosis occurs in 5-15% of allogeneic hematopoietic stem cell transplant (HSCT) recipients. Through the 1990s there has been an increase in the incidence of late aspergillosis (LA). We report on the incidence, risk factors, and attributable mortality of LA in a cohort of 398 adult and pediatric patients at Memorial Sloan-Kettering Cancer Center from January 1999 through December 2003. Methods. LA was defined as occurring >40 days post HSCT. LA cases were identified by prospective surveillance and examination of a computerized database. Probable or definite aspergillosis was defined by standard EORTC/MSG criteria. Mortality was attributed to LA if it caused or significantly contributed to death. Results. The overall incidence of LA in our cohort was 4.1%. Median time from stem cell infusion to diagnosis of LA was 164 days (range 68-677) after HSCT. The incidence of LA among unmodified, T-cell depleted, or reduced intensity HSCT was 2.2%, 4%, and 6.8%, respectively (P not significant). Risk factors for LA were grade II-IV acute graft-versus-host disease (GVHD) (P=0.002), chronic GVHD (P=0.01), secondary neutropenia (P=0.02), and reduced intensity conditioning containing alemtuzumab (P=0.01). LA was the immediate cause of death in 1 of 10 (10%) T-cell depleted, 2 of 2 (100%) unmodified, and 1 of 4 (25%) of reduced-intensity HSCT. Conclusions. LA developed a median 164 days post HSCT. All-cause 30-day mortality of LA was 56.3%. The majority of LA cases died of concurrent infections and not from invasive aspergillosis. Copyright © Blackwell Munksgaard 2007.
Keywords: adolescent; adult; child; human tissue; aged; child, preschool; middle aged; major clinical study; allogeneic stem cell transplantation; histopathology; mortality; neutropenia; incidence; cohort analysis; risk factors; aciclovir; herpes simplex; hematopoietic stem cell transplantation; data base; risk factor; statistical analysis; infant; prophylaxis; graft versus host reaction; allogeneic hematopoietic stem cell transplantation; t cell depletion; caspofungin; fluconazole; ganciclovir; pentamidine; candidiasis; voriconazole; lymphocyte depletion; aspergillosis; graft recipient; alemtuzumab; micafungin; chickenpox; hematologic disease; itraconazole; immunosuppression; drug indication; amphotericin b lipid complex; late aspergillosis; t-cell depleted; mixed infection
Journal Title: Transplant Infectious Disease
Volume: 10
Issue: 3
ISSN: 1398-2273
Publisher: Wiley Blackwell  
Date Published: 2008-06-01
Start Page: 162
End Page: 167
Language: English
DOI: 10.1111/j.1399-3062.2007.00272.x
PUBMED: 17662036
PROVIDER: scopus
DOI/URL:

http://www.scopus.com/inward/record.url?eid=2-s2.0-43949095836&partnerID=40&md5=3fb6f8df8da6529c874e2ca22f381420
Notes: --- - "Cited By (since 1996): 11" - "Export Date: 17 November 2011" - "CODEN: TIDSF" - "Source: Scopus"
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MSK Authors
  1. Emerson Randall King
    1 King
  2. Coralia N Mihu
    6 Mihu
  3. Eric Pamer
    283 Pamer
  4. Genovefa A Papanicolaou
    238 Papanicolaou
  5. Ann Jakubowski
    455 Jakubowski
  6. Ying Taur
    147 Taur
  7. Ofer Yossepowitch
    33 Yossepowitch
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