Risk factors and prognosis of invasive fungal infections in allogeneic stem cell transplantation recipients: a single-institution experience

Abstract

Invasive fungal infections (IFI) are frequent complications of allogeneic hematopoietic stem cell transplantation (SCT) and major causes of a poor prognosis. Analysis of risk factors and prognosis of IFI are important for the control of IFI. We retrospectively reviewed the medical records of all allogeneic SCT recipients from January 2000 to December 2007. For the homogeneity of analysis, only 286 patients with no history of IFI were included. Fifty-five cases of IFI were identified, corresponding to cumulative incidence of 19.8%. Different overall survival rates were recorded in patients with or without IFI (20.3% vs. 55.3%, P=0.004). Multivariate analysis identified 2 risk factors of IFI: use of high-dose steroid and cytomegalovirus infections, and risk stratification can classify the patients into 3 subgroups with different incidences of IFI (9.2%, 25.4%, and 34.1%, P=0.0007). Further analysis confirmed use of steroid as a risk factor of inferior prognosis in IFI cases (0 vs. 57.1%, P<0.0001), which was due to higher rates of IFI-related mortality (64.7% vs. 23.9%, P=0.018). Post-transplant IFI was an unfavorable prognostic factor of the SCT recipients, and risk stratification can identify patients with high risk of IFI. Use of steroid played an important role in the pathogenesis as well as prognosis of IFI.