Risk factors and impact of non-Aspergillus mold infections following allogeneic HCT: A CIBMTR infection and immune reconstitution analysis

M. L. Riches; S. Trifilio; M. Chen; K. W. Ahn; A. Langston; H. M. Lazarus; D. I. Marks; R. Martino; R. T. Maziarz; G. A. Papanicolou; J. R. Wingard; J. A H Young; C. L. Bennett

doi:10.1038/bmt.2015.263

Risk factors and impact of non-Aspergillus mold infections following allogeneic HCT: A CIBMTR infection and immune reconstitution analysis

M. L. Riches, S. Trifilio, M. Chen, K. W. Ahn, A. Langston, H. M. Lazarus, D. I. Marks, R. Martino, R. T. Maziarz, G. A. Papanicolou, J. R. Wingard, J. A H Young, C. L. Bennett

Medicine - Infectious Disease and International

Research output: Contribution to journal › Article › peer-review

27 Scopus citations

Abstract

Risk factors for non-Aspergillus mold infection (NAMI) and the impact on transplant outcome are poorly assessed in the current era of antifungal agents. Outcomes of 124 patients receiving allogeneic hematopoietic cell transplantation (HCT) diagnosed with either mucormycosis (n=72) or fusariosis (n=52) between days 0 and 365 after HCT are described and compared with a control cohort (n=11 856). Patients with NAMI had more advanced disease (mucormycois: 25%, fusariosis: 23% and controls: 18%; P=0.004) and were more likely to have a Karnofsky performance status (KPS) <90% at HCT (mucormycosis: 42%, fusariosis: 38% and controls: 28%; P=0.048). The 1-year survival after HCT was 22% (15-29%) for cases and was significantly inferior compared with controls (65% (64-65%); P<0.001). Survival from infection was similarly dismal regardless of mucormycosis: 15% (8-25%) and fusariosis: 21% (11-33%). In multivariable analysis, NAMI was associated with a sixfold higher risk of death (P<0.0001) regardless of the site or timing of infection. Risk factors for mucormycosis include preceding acute GvHD, prior Aspergillus infection and older age. For fusariosis, increased risks including receipt of cord blood, prior CMV infection and transplant before May 2002. In conclusion, NAMI occurs infrequently, is associated with high mortality and appears with similar frequency in the current antifungal era.

Original language	English (US)
Pages (from-to)	277-282
Number of pages	6
Journal	Bone marrow transplantation
Volume	51
Issue number	2
DOIs	https://doi.org/10.1038/bmt.2015.263
State	Published - Feb 1 2016

Bibliographical note

Funding Information:
The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two grants N00014-13-1-0039 and N00014-14-1-0028 from the Office of Naval Research; and grants from *Actinium Pharmaceuticals, Allos Therapeutics, Inc., *Amgen, Inc., anonymous donation to the Medical College of Wisconsin, Ariad, Be the Match Foundation, *Blue Cross and Blue Shield Association, *Celgene Corporation, Chimerix, Inc., Fred Hutchinson Cancer Research Center, Fresenius-Biotech North America, Inc., *Gamida Cell Teva Joint Venture Ltd., Genentech, Inc., *Gentium SpA, Genzyme Corporation, GlaxoSmithKline, Health Research, Inc., Roswell Park Cancer Institute, HistoGenetics, Inc., Incyte Corporation, Jeff Gordon Children’s Foundation, Kiadis Pharma, The Leukemia & Lymphoma Society, Medac GmbH, The Medical College of Wisconsin, Merck & Co, Inc., Millennium: The Takeda Oncology Co., *Milliman USA, Inc., *Miltenyi Biotec, Inc., National Marrow Donor Program, Onyx Pharmaceuticals, Optum Healthcare Solutions, Inc., Osiris Therapeutics, Inc., Otsuka America Pharmaceutical, Inc., Perkin Elmer, Inc., *Remedy Informatics, *Sanofi US, Seattle Genetics, Sigma-Tau Pharmaceuticals, Soligenix, Inc., St Baldrick’s Foundation, StemCyte, A Global Cord Blood Therapeutics Co., Stemsoft Software, Inc., Swedish Orphan Biovitrum, *Tarix Pharmaceuticals, *TerumoBCT, *Teva Neuroscience, Inc., *THERAKOS, Inc., University of Minnesota, University of Utah and *Wellpoint, Inc. *These are the Corporate Members.

Funding Information:
The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two grants N00014-13-1-0039 and N00014-14-1-0028 from the Office of Naval Research; and grants from ?Actinium Pharmaceuticals, Allos Therapeutics, Inc., ?Amgen, Inc., anonymous donation to the Medical College of Wisconsin, Ariad, Be the Match Foundation, ?Blue Cross and Blue Shield Association, ?Celgene Corporation, Chimerix, Inc., Fred Hutchinson Cancer Research Center, Fresenius- Biotech North America, Inc., ?Gamida Cell Teva Joint Venture Ltd., Genentech, Inc., ?Gentium SpA, Genzyme Corporation, GlaxoSmithKline, Health Research, Inc., Roswell Park Cancer Institute, HistoGenetics, Inc., Incyte Corporation, Jeff Gordon Children?s Foundation, Kiadis Pharma, The Leukemia & Lymphoma Society, Medac GmbH, The Medical College of Wisconsin, Merck & Co, Inc., Millennium: The Takeda Oncology Co., ?Milliman USA, Inc., ?Miltenyi Biotec, Inc., National Marrow Donor Program, Onyx Pharmaceuticals, Optum Healthcare Solutions, Inc., Osiris Therapeutics, Inc., Otsuka America Pharmaceutical, Inc., Perkin Elmer, Inc., ?Remedy Informatics, ?Sanofi US, Seattle Genetics, Sigma-Tau Pharmaceuticals, Soligenix, Inc., St Baldrick?s Foundation, StemCyte, A Global Cord Blood Therapeutics Co., Stemsoft Software, Inc., Swedish Orphan Biovitrum, ?Tarix Pharmaceuticals, ?TerumoBCT, ?Teva Neuroscience, Inc., ?THERAKOS, Inc., University of Minnesota, University of Utah and ?Wellpoint, Inc. ?These are the Corporate Members.

Funding Information:
The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two grants N00014-13-1-0039 and N00014-14-1-0028 from the Office of Naval Research; and grants from ∗Actinium Pharmaceuticals, Allos Therapeutics, Inc., ∗Amgen, Inc., anonymous donation to the Medical College of Wisconsin, Ariad, Be the Match Foundation, ∗Blue Cross and Blue Shield Association, ∗Celgene Corporation, Chimerix, Inc., Fred Hutchinson Cancer Research Center, Fresenius- Biotech North America, Inc., ∗Gamida Cell Teva Joint Venture Ltd., Genentech, Inc., ∗Gentium SpA, Genzyme Corporation, GlaxoSmithKline, Health Research, Inc., Roswell Park Cancer Institute, HistoGenetics, Inc., Incyte Corporation, Jeff Gordon Children’s Foundation, Kiadis Pharma, The Leukemia & Lymphoma Society, Medac GmbH, The Medical College of Wisconsin, Merck & Co, Inc., Millennium: The Takeda Oncology Co., ∗Milliman USA, Inc., ∗Miltenyi Biotec, Inc., National Marrow Donor Program, Onyx Pharmaceuticals, Optum Healthcare Solutions, Inc., Osiris Therapeutics, Inc., Otsuka America Pharmaceutical, Inc., Perkin Elmer, Inc., ∗Remedy Informatics, ∗Sanofi US, Seattle Genetics, Sigma-Tau Pharmaceuticals, Soligenix, Inc., St Baldrick’s Foundation, StemCyte, A Global Cord Blood Therapeutics Co., Stemsoft Software, Inc., Swedish Orphan Biovitrum, ∗Tarix Pharmaceuticals, ∗TerumoBCT, ∗Teva Neuroscience, Inc., ∗THERAKOS, Inc., University of Minnesota, University of Utah and ∗Wellpoint, Inc. ∗These are the Corporate Members.

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© 2016 Macmillan Publishers Limited All rights reserved.

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Riches, M. L., Trifilio, S., Chen, M., Ahn, K. W., Langston, A., Lazarus, H. M., Marks, D. I., Martino, R., Maziarz, R. T., Papanicolou, G. A., Wingard, J. R., Young, J. A. H., & Bennett, C. L. (2016). Risk factors and impact of non-Aspergillus mold infections following allogeneic HCT: A CIBMTR infection and immune reconstitution analysis. Bone marrow transplantation, 51(2), 277-282. https://doi.org/10.1038/bmt.2015.263

Riches, ML, Trifilio, S, Chen, M, Ahn, KW, Langston, A, Lazarus, HM, Marks, DI, Martino, R, Maziarz, RT, Papanicolou, GA, Wingard, JR, Young, JAH & Bennett, CL 2016, 'Risk factors and impact of non-Aspergillus mold infections following allogeneic HCT: A CIBMTR infection and immune reconstitution analysis', Bone marrow transplantation, vol. 51, no. 2, pp. 277-282. https://doi.org/10.1038/bmt.2015.263

@article{1bc475f43d9149b39d8e7784326d8e9a,

title = "Risk factors and impact of non-Aspergillus mold infections following allogeneic HCT: A CIBMTR infection and immune reconstitution analysis",

abstract = "Risk factors for non-Aspergillus mold infection (NAMI) and the impact on transplant outcome are poorly assessed in the current era of antifungal agents. Outcomes of 124 patients receiving allogeneic hematopoietic cell transplantation (HCT) diagnosed with either mucormycosis (n=72) or fusariosis (n=52) between days 0 and 365 after HCT are described and compared with a control cohort (n=11 856). Patients with NAMI had more advanced disease (mucormycois: 25%, fusariosis: 23% and controls: 18%; P=0.004) and were more likely to have a Karnofsky performance status (KPS) <90% at HCT (mucormycosis: 42%, fusariosis: 38% and controls: 28%; P=0.048). The 1-year survival after HCT was 22% (15-29%) for cases and was significantly inferior compared with controls (65% (64-65%); P<0.001). Survival from infection was similarly dismal regardless of mucormycosis: 15% (8-25%) and fusariosis: 21% (11-33%). In multivariable analysis, NAMI was associated with a sixfold higher risk of death (P<0.0001) regardless of the site or timing of infection. Risk factors for mucormycosis include preceding acute GvHD, prior Aspergillus infection and older age. For fusariosis, increased risks including receipt of cord blood, prior CMV infection and transplant before May 2002. In conclusion, NAMI occurs infrequently, is associated with high mortality and appears with similar frequency in the current antifungal era.",

author = "Riches, {M. L.} and S. Trifilio and M. Chen and Ahn, {K. W.} and A. Langston and Lazarus, {H. M.} and Marks, {D. I.} and R. Martino and Maziarz, {R. T.} and Papanicolou, {G. A.} and Wingard, {J. R.} and Young, {J. A H} and Bennett, {C. L.}",

note = "Funding Information: The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two grants N00014-13-1-0039 and N00014-14-1-0028 from the Office of Naval Research; and grants from *Actinium Pharmaceuticals, Allos Therapeutics, Inc., *Amgen, Inc., anonymous donation to the Medical College of Wisconsin, Ariad, Be the Match Foundation, *Blue Cross and Blue Shield Association, *Celgene Corporation, Chimerix, Inc., Fred Hutchinson Cancer Research Center, Fresenius-Biotech North America, Inc., *Gamida Cell Teva Joint Venture Ltd., Genentech, Inc., *Gentium SpA, Genzyme Corporation, GlaxoSmithKline, Health Research, Inc., Roswell Park Cancer Institute, HistoGenetics, Inc., Incyte Corporation, Jeff Gordon Children{\textquoteright}s Foundation, Kiadis Pharma, The Leukemia & Lymphoma Society, Medac GmbH, The Medical College of Wisconsin, Merck & Co, Inc., Millennium: The Takeda Oncology Co., *Milliman USA, Inc., *Miltenyi Biotec, Inc., National Marrow Donor Program, Onyx Pharmaceuticals, Optum Healthcare Solutions, Inc., Osiris Therapeutics, Inc., Otsuka America Pharmaceutical, Inc., Perkin Elmer, Inc., *Remedy Informatics, *Sanofi US, Seattle Genetics, Sigma-Tau Pharmaceuticals, Soligenix, Inc., St Baldrick{\textquoteright}s Foundation, StemCyte, A Global Cord Blood Therapeutics Co., Stemsoft Software, Inc., Swedish Orphan Biovitrum, *Tarix Pharmaceuticals, *TerumoBCT, *Teva Neuroscience, Inc., *THERAKOS, Inc., University of Minnesota, University of Utah and *Wellpoint, Inc. *These are the Corporate Members. Funding Information: The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two grants N00014-13-1-0039 and N00014-14-1-0028 from the Office of Naval Research; and grants from ?Actinium Pharmaceuticals, Allos Therapeutics, Inc., ?Amgen, Inc., anonymous donation to the Medical College of Wisconsin, Ariad, Be the Match Foundation, ?Blue Cross and Blue Shield Association, ?Celgene Corporation, Chimerix, Inc., Fred Hutchinson Cancer Research Center, Fresenius- Biotech North America, Inc., ?Gamida Cell Teva Joint Venture Ltd., Genentech, Inc., ?Gentium SpA, Genzyme Corporation, GlaxoSmithKline, Health Research, Inc., Roswell Park Cancer Institute, HistoGenetics, Inc., Incyte Corporation, Jeff Gordon Children?s Foundation, Kiadis Pharma, The Leukemia & Lymphoma Society, Medac GmbH, The Medical College of Wisconsin, Merck & Co, Inc., Millennium: The Takeda Oncology Co., ?Milliman USA, Inc., ?Miltenyi Biotec, Inc., National Marrow Donor Program, Onyx Pharmaceuticals, Optum Healthcare Solutions, Inc., Osiris Therapeutics, Inc., Otsuka America Pharmaceutical, Inc., Perkin Elmer, Inc., ?Remedy Informatics, ?Sanofi US, Seattle Genetics, Sigma-Tau Pharmaceuticals, Soligenix, Inc., St Baldrick?s Foundation, StemCyte, A Global Cord Blood Therapeutics Co., Stemsoft Software, Inc., Swedish Orphan Biovitrum, ?Tarix Pharmaceuticals, ?TerumoBCT, ?Teva Neuroscience, Inc., ?THERAKOS, Inc., University of Minnesota, University of Utah and ?Wellpoint, Inc. ?These are the Corporate Members. Funding Information: The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two grants N00014-13-1-0039 and N00014-14-1-0028 from the Office of Naval Research; and grants from ∗Actinium Pharmaceuticals, Allos Therapeutics, Inc., ∗Amgen, Inc., anonymous donation to the Medical College of Wisconsin, Ariad, Be the Match Foundation, ∗Blue Cross and Blue Shield Association, ∗Celgene Corporation, Chimerix, Inc., Fred Hutchinson Cancer Research Center, Fresenius- Biotech North America, Inc., ∗Gamida Cell Teva Joint Venture Ltd., Genentech, Inc., ∗Gentium SpA, Genzyme Corporation, GlaxoSmithKline, Health Research, Inc., Roswell Park Cancer Institute, HistoGenetics, Inc., Incyte Corporation, Jeff Gordon Children{\textquoteright}s Foundation, Kiadis Pharma, The Leukemia & Lymphoma Society, Medac GmbH, The Medical College of Wisconsin, Merck & Co, Inc., Millennium: The Takeda Oncology Co., ∗Milliman USA, Inc., ∗Miltenyi Biotec, Inc., National Marrow Donor Program, Onyx Pharmaceuticals, Optum Healthcare Solutions, Inc., Osiris Therapeutics, Inc., Otsuka America Pharmaceutical, Inc., Perkin Elmer, Inc., ∗Remedy Informatics, ∗Sanofi US, Seattle Genetics, Sigma-Tau Pharmaceuticals, Soligenix, Inc., St Baldrick{\textquoteright}s Foundation, StemCyte, A Global Cord Blood Therapeutics Co., Stemsoft Software, Inc., Swedish Orphan Biovitrum, ∗Tarix Pharmaceuticals, ∗TerumoBCT, ∗Teva Neuroscience, Inc., ∗THERAKOS, Inc., University of Minnesota, University of Utah and ∗Wellpoint, Inc. ∗These are the Corporate Members. Publisher Copyright: {\textcopyright} 2016 Macmillan Publishers Limited All rights reserved.",

year = "2016",

month = feb,

day = "1",

doi = "10.1038/bmt.2015.263",

language = "English (US)",

volume = "51",

pages = "277--282",

journal = "Bone marrow transplantation",

issn = "0268-3369",

publisher = "Nature Publishing Group",

number = "2",

}

TY - JOUR

T1 - Risk factors and impact of non-Aspergillus mold infections following allogeneic HCT

T2 - A CIBMTR infection and immune reconstitution analysis

AU - Riches, M. L.

AU - Trifilio, S.

AU - Chen, M.

AU - Ahn, K. W.

AU - Langston, A.

AU - Lazarus, H. M.

AU - Marks, D. I.

AU - Martino, R.

AU - Maziarz, R. T.

AU - Papanicolou, G. A.

AU - Wingard, J. R.

AU - Young, J. A H

AU - Bennett, C. L.

N1 - Funding Information: The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two grants N00014-13-1-0039 and N00014-14-1-0028 from the Office of Naval Research; and grants from *Actinium Pharmaceuticals, Allos Therapeutics, Inc., *Amgen, Inc., anonymous donation to the Medical College of Wisconsin, Ariad, Be the Match Foundation, *Blue Cross and Blue Shield Association, *Celgene Corporation, Chimerix, Inc., Fred Hutchinson Cancer Research Center, Fresenius-Biotech North America, Inc., *Gamida Cell Teva Joint Venture Ltd., Genentech, Inc., *Gentium SpA, Genzyme Corporation, GlaxoSmithKline, Health Research, Inc., Roswell Park Cancer Institute, HistoGenetics, Inc., Incyte Corporation, Jeff Gordon Children’s Foundation, Kiadis Pharma, The Leukemia & Lymphoma Society, Medac GmbH, The Medical College of Wisconsin, Merck & Co, Inc., Millennium: The Takeda Oncology Co., *Milliman USA, Inc., *Miltenyi Biotec, Inc., National Marrow Donor Program, Onyx Pharmaceuticals, Optum Healthcare Solutions, Inc., Osiris Therapeutics, Inc., Otsuka America Pharmaceutical, Inc., Perkin Elmer, Inc., *Remedy Informatics, *Sanofi US, Seattle Genetics, Sigma-Tau Pharmaceuticals, Soligenix, Inc., St Baldrick’s Foundation, StemCyte, A Global Cord Blood Therapeutics Co., Stemsoft Software, Inc., Swedish Orphan Biovitrum, *Tarix Pharmaceuticals, *TerumoBCT, *Teva Neuroscience, Inc., *THERAKOS, Inc., University of Minnesota, University of Utah and *Wellpoint, Inc. *These are the Corporate Members. Funding Information: The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two grants N00014-13-1-0039 and N00014-14-1-0028 from the Office of Naval Research; and grants from ?Actinium Pharmaceuticals, Allos Therapeutics, Inc., ?Amgen, Inc., anonymous donation to the Medical College of Wisconsin, Ariad, Be the Match Foundation, ?Blue Cross and Blue Shield Association, ?Celgene Corporation, Chimerix, Inc., Fred Hutchinson Cancer Research Center, Fresenius- Biotech North America, Inc., ?Gamida Cell Teva Joint Venture Ltd., Genentech, Inc., ?Gentium SpA, Genzyme Corporation, GlaxoSmithKline, Health Research, Inc., Roswell Park Cancer Institute, HistoGenetics, Inc., Incyte Corporation, Jeff Gordon Children?s Foundation, Kiadis Pharma, The Leukemia & Lymphoma Society, Medac GmbH, The Medical College of Wisconsin, Merck & Co, Inc., Millennium: The Takeda Oncology Co., ?Milliman USA, Inc., ?Miltenyi Biotec, Inc., National Marrow Donor Program, Onyx Pharmaceuticals, Optum Healthcare Solutions, Inc., Osiris Therapeutics, Inc., Otsuka America Pharmaceutical, Inc., Perkin Elmer, Inc., ?Remedy Informatics, ?Sanofi US, Seattle Genetics, Sigma-Tau Pharmaceuticals, Soligenix, Inc., St Baldrick?s Foundation, StemCyte, A Global Cord Blood Therapeutics Co., Stemsoft Software, Inc., Swedish Orphan Biovitrum, ?Tarix Pharmaceuticals, ?TerumoBCT, ?Teva Neuroscience, Inc., ?THERAKOS, Inc., University of Minnesota, University of Utah and ?Wellpoint, Inc. ?These are the Corporate Members. Funding Information: The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID); a Grant/Cooperative Agreement 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration (HRSA/DHHS); two grants N00014-13-1-0039 and N00014-14-1-0028 from the Office of Naval Research; and grants from ∗Actinium Pharmaceuticals, Allos Therapeutics, Inc., ∗Amgen, Inc., anonymous donation to the Medical College of Wisconsin, Ariad, Be the Match Foundation, ∗Blue Cross and Blue Shield Association, ∗Celgene Corporation, Chimerix, Inc., Fred Hutchinson Cancer Research Center, Fresenius- Biotech North America, Inc., ∗Gamida Cell Teva Joint Venture Ltd., Genentech, Inc., ∗Gentium SpA, Genzyme Corporation, GlaxoSmithKline, Health Research, Inc., Roswell Park Cancer Institute, HistoGenetics, Inc., Incyte Corporation, Jeff Gordon Children’s Foundation, Kiadis Pharma, The Leukemia & Lymphoma Society, Medac GmbH, The Medical College of Wisconsin, Merck & Co, Inc., Millennium: The Takeda Oncology Co., ∗Milliman USA, Inc., ∗Miltenyi Biotec, Inc., National Marrow Donor Program, Onyx Pharmaceuticals, Optum Healthcare Solutions, Inc., Osiris Therapeutics, Inc., Otsuka America Pharmaceutical, Inc., Perkin Elmer, Inc., ∗Remedy Informatics, ∗Sanofi US, Seattle Genetics, Sigma-Tau Pharmaceuticals, Soligenix, Inc., St Baldrick’s Foundation, StemCyte, A Global Cord Blood Therapeutics Co., Stemsoft Software, Inc., Swedish Orphan Biovitrum, ∗Tarix Pharmaceuticals, ∗TerumoBCT, ∗Teva Neuroscience, Inc., ∗THERAKOS, Inc., University of Minnesota, University of Utah and ∗Wellpoint, Inc. ∗These are the Corporate Members. Publisher Copyright: © 2016 Macmillan Publishers Limited All rights reserved.

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Risk factors for non-Aspergillus mold infection (NAMI) and the impact on transplant outcome are poorly assessed in the current era of antifungal agents. Outcomes of 124 patients receiving allogeneic hematopoietic cell transplantation (HCT) diagnosed with either mucormycosis (n=72) or fusariosis (n=52) between days 0 and 365 after HCT are described and compared with a control cohort (n=11 856). Patients with NAMI had more advanced disease (mucormycois: 25%, fusariosis: 23% and controls: 18%; P=0.004) and were more likely to have a Karnofsky performance status (KPS) <90% at HCT (mucormycosis: 42%, fusariosis: 38% and controls: 28%; P=0.048). The 1-year survival after HCT was 22% (15-29%) for cases and was significantly inferior compared with controls (65% (64-65%); P<0.001). Survival from infection was similarly dismal regardless of mucormycosis: 15% (8-25%) and fusariosis: 21% (11-33%). In multivariable analysis, NAMI was associated with a sixfold higher risk of death (P<0.0001) regardless of the site or timing of infection. Risk factors for mucormycosis include preceding acute GvHD, prior Aspergillus infection and older age. For fusariosis, increased risks including receipt of cord blood, prior CMV infection and transplant before May 2002. In conclusion, NAMI occurs infrequently, is associated with high mortality and appears with similar frequency in the current antifungal era.

AB - Risk factors for non-Aspergillus mold infection (NAMI) and the impact on transplant outcome are poorly assessed in the current era of antifungal agents. Outcomes of 124 patients receiving allogeneic hematopoietic cell transplantation (HCT) diagnosed with either mucormycosis (n=72) or fusariosis (n=52) between days 0 and 365 after HCT are described and compared with a control cohort (n=11 856). Patients with NAMI had more advanced disease (mucormycois: 25%, fusariosis: 23% and controls: 18%; P=0.004) and were more likely to have a Karnofsky performance status (KPS) <90% at HCT (mucormycosis: 42%, fusariosis: 38% and controls: 28%; P=0.048). The 1-year survival after HCT was 22% (15-29%) for cases and was significantly inferior compared with controls (65% (64-65%); P<0.001). Survival from infection was similarly dismal regardless of mucormycosis: 15% (8-25%) and fusariosis: 21% (11-33%). In multivariable analysis, NAMI was associated with a sixfold higher risk of death (P<0.0001) regardless of the site or timing of infection. Risk factors for mucormycosis include preceding acute GvHD, prior Aspergillus infection and older age. For fusariosis, increased risks including receipt of cord blood, prior CMV infection and transplant before May 2002. In conclusion, NAMI occurs infrequently, is associated with high mortality and appears with similar frequency in the current antifungal era.

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U2 - 10.1038/bmt.2015.263

DO - 10.1038/bmt.2015.263

M3 - Article

C2 - 26524262

AN - SCOPUS:84956914523

SN - 0268-3369

VL - 51

SP - 277

EP - 282

JO - Bone marrow transplantation

JF - Bone marrow transplantation

IS - 2

ER -

Risk factors and impact of non-Aspergillus mold infections following allogeneic HCT: A CIBMTR infection and immune reconstitution analysis

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