PS1286 INVASIVE YEAST INFECTIONS IN HEMATOLOGICAL PATIENTS AFTER HEMATOPOIETIC STEM CELL TRANSPLANTATION

Abstract

Background:Invasive yeast infection is rare invasive fungal disease but associated with high mortality rate in hematological patients. Data on Invasive yeast infection in hematopoietic stem cell transplantation (HSCT) recipients are limited.Aims:The aim of our study was to estimate epidemiology of invasive yeast infections in large HSCT recipients’ cohort for the 10‐year period transplant activity in CIC725.Methods:Between 2008 and 2017 2430 stem cell transplantation have been performed in CIC 725: 1647 allogeneic HSCT and 783 autologous HSCT. A retrospective study included 30 cases of invasive yeast infections in patients with hematological malignances and non‐malignant hematological diseases after HSCT. EORTC/MSG 2008 criteria were used for the diagnosis of proven yeast infections as well as to evaluate response to therapy.Results:Incidence of invasive yeast infections for the 10‐year period of high transplant activity was 1,2%: 1,4% in allo‐HSCT recipients (n = 23), 0,9% – auto‐HSCT (n = 7) predominantly in patients with acute leukemia – 67% (n = 20). The median age was 10 y.o. (range, 1 month‐59 years). In study population allo‐HSCT from unrelated donor was performed in 50% (n = 15), haplo‐HSCT in 27% (n = 8) and auto‐HSCT in 23% (n = 7). In study cohort 30% of patients had no complete remission at the moment of HSCT. As a primary antifungal prophylaxis was used: fluconazole – 37% (n = 11), echinocandins – 13% (n = 4), without prophylaxis – 23% (n = 7); as a secondary prophylaxis – voriconazole in 27% (n = 8). The median day of onset of invasive yeast infections after allo‐HSCT was 109 days (3–1337), auto‐HSCT – 20 days (8–33). The etiology of invasive yeast infections was: Candida spp. – 87% (n = 26), Malassezia furfur – 7% (n = 2), Trichosporon asahii – 3% (n = 1), Cryptococcus spp. – 3% (n = 1). Febrile fever was the main clinical symptom and septic syndrome developed in 60% of cases. OS at 30 days from diagnosis of invasive yeast infection was 63%. The central venous catheter removal was the only factor significantly improved OS at 30 days after invasive yeast infection diagnosis (91% vs 17%, p = 0,001).Summary/Conclusion:Incidence of invasive yeast infections for the 10 years of observation was 1,2%: 1,4% in allo‐HSCT recipients, 0,9% – auto‐HSCT. The main etiology was Candida spp. (87%). Overall survival at 30 days from the diagnosis of invasive yeast infections was 60%. Removing of central venous catheter improved overall survival in hematological patients after HSCT with invasive yeast infections.