Incidence of Invasive Fungal Disease After Unmanipulated Haploidentical Stem Cell Transplantation Was Significantly Higher Than That After HLA-Matched Sibling Transplantation

Abstract

The aim of this study was to determine the incidence, clinical features and outcome of invasive fungal disease (IFD) after either an unmanipulated haploidentical hematopoietic stem cell transplantation (HSCT) or a human leukocyte antigen (HLA)-matched sibling HSCT. This was a head-to-head comparative study performed at a single center. 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 1,042 consecutive patients enrolled, 390 received the HLA-matched HSCT and 652 received an unmanipulated haploidentical HSCT. A total of 61 (5.8%) patients had IFD, which was broken down into 15 proven cases and 46 probable cases. The median time of diagnosis was 35 days (range 6-405) after transplantation. The most common involved site was the lung (52/61), and Aspergillus was the most common (18/29) pathogen. The incidence of IFD after an unmanipulated haploidentical HSCT was significantly higher than the HLA-matched transplant (7.1% versus 3.3%, respectively, P = .007), which was caused by the more early IFD (before day 40). IFD occurred later in patients receiving an HLA-matched transplant compared to patients receiving the unmanipulated haploidentical HSCT (141.5 versus 23 days, respectively, P = .04). The response to therapy and the mortality rate corresponding to IFD were similar between the two types of transplantation. In conclusion, patients received an unmanipulated haploidentical HSCT had higher risk of IFD than those patients received an HLA-matched HSCT, but the prognosis of IFD was not associated with the HLA type.