Invasive fungal disease in patients undergoing umbilical cord blood transplantation after myeloablative conditioning regimen.

Abstract

Characteristics and risk factors (RFs) of invasive fungal disease (IFD) have been little studied in the setting of umbilical cord blood transplantation (UCBT). We retrospectively included 205 single-unit myeloablative UCBT recipients with a median follow-up of 64months. Fifty-six episodes of IFD were observed in 48 patients (23%) at a median time of 123days after stem cell infusion. Invasive mold disease (IMD) occurred in 42 cases, 38 of them (90%) caused by invasive aspergillosis whereas invasive yeast disease (IYD) occurred in 14 cases, most of them due to candidemia (n=12, 86%). The 5-year cumulative incidence of IFD, IMDs, and IYDs was 24% 19%, and 7%, respectively. In multivariate analysis, three RFs for IMDs were identified: age >30years (HR 3.5, P=0.017), acute grade II-IV graft-versus-host disease (HR 2.3, P=0.011), and ≥1 previous transplant (HR 3.1, P=0.012). The probability of IMDs was 2.5%, 14%, and 33% for recipients with none, 1, or 2-3 RFs, respectively (P<0.001). Among IFD, IMDs had a negative effect on non-relapse mortality in multivariate analysis (HR 1.6, P=0.039). IMDs showed a negative impacton overallsurvival (HR 1.59, P=0.018). Invasive mold disease were very common and serious complication after UCBT.