TY - JOUR
T1 - Epidemiology and outcome of invasive fungal infection in adult hematopoietic stem cell transplant recipients
T2 - Analysis of multicenter prospective antifungal therapy (PATH) alliance registry
AU - Neofytos, Dionissios
AU - Horn, D.
AU - Anaissie, E.
AU - Steinbach, W.
AU - Olyaei, A.
AU - Fishman, J.
AU - Pfaller, M.
AU - Chang, C.
AU - Webster, K.
AU - Marr, K.
N1 - Funding Information:
Potential conflicts of interest. D.N. has received grant support (for educational research) from Astellas. D.H. has received research funding from Astellas and Pfizer, has served as a consultant or advisor to Astellas and Pfizer, has been on the speakers’ bureau for Pfizer and Astellas, and has received speaking honoraria from Roche. E.A. has been a consultant to and on the speakers’ bureau for Astellas, Pfizer, Gilead, Merck, and Schering-Plough. W.S. has served as consultant to Pfizer, Astellas, and Schering-Plough and on the speakers’ bureau for Astellas, Merck, Pfizer. A.O. has been on the speakers’ bureau and served as consultant to Pfizer and Astellas. J.F. has been a consultant to Merck, Hoffman LaRoche, As-tellas, and Primera; has received grant support (for educational research) from Astellas; and has been on the speakers’ bureau for Astellas and Roche. M.P. has been a consultant to and on the speakers’ bureau for Pfizer, Astellas, Merck, and Schering-Plough. C.C. has served as a statistical consultant to Pharmacia, Pfizer, and Eli Lilly; as a marketing analytics consultant to Roche; and as a statistical consultant via third parties to Astellas, Topigen, and AstraZeneca. K.W. has had contract work with Astellas. K.M. has been a consultant and/or part of advisory boards for Astellas, Enzon, Merck, Pfizer, and Schering Plough and has received grant support from Astellas, Enzon, Merck, and Pfizer.
PY - 2009/2/1
Y1 - 2009/2/1
N2 - Background. With use of data from the Prospective Antifungal Therapy (PATH) Alliance registry, we performed this multicenter, prospective, observational study to assess the epidemiologic characters and outcomes of invasive fungal infection (IFI) in hematopoietic stem cell transplant (HSCT) recipients. Methods. Sixteen medical centers from North America reported data on adult HSCT recipients with proven or probable IFI during the period July 2004 through September 2007. The distribution of IFIs and rates of survival at 6 and 12 weeks after diagnosis were studied. We used logistic regression models to determine risk factors associated with 6-week mortality for allogeneic HSCT recipients with invasive aspergillosis (IA). Results. Two hundred thirty-four adult HSCT recipients with a total of 250 IFIs were included in this study. IA (59.2%) was the most frequent IFI, followed by invasive candidiasis (24.8%), zygomycosis (7.2%), and IFI due to other molds (6.8%). Voriconazole was the most frequently administered agent (68.4%); amphotericin B deoxycholate was administered to a few patients (2.1%). Ninety-three (46.7%) of 199 HSCT recipients with known outcome had died by week 12. The 6-week survival rate was significantly greater for patients with IA than for those with invasive candidiasis and for those with IFI due to the Zygomycetes or other molds (P < .001). The 6-week mortality rate for HSCT recipients with IA was 21.5%. At 6 weeks, there was a trend toward a worse outcome among allogeneic HSCT recipients with IA who received myeloablative conditioning (P = .07); absence of mechanical ventilation or/and hemodialysis (P = .01) were associated with improved survival. Conclusions. IA remains the most commonly identified IFI among HSCT recipients, but rates of survival in persons with IA appear to have improved, compared with previously reported data. Invasive candidiasis and IFI due to molds other than Aspergillus species remain a significant problem in HSCT recipients.
AB - Background. With use of data from the Prospective Antifungal Therapy (PATH) Alliance registry, we performed this multicenter, prospective, observational study to assess the epidemiologic characters and outcomes of invasive fungal infection (IFI) in hematopoietic stem cell transplant (HSCT) recipients. Methods. Sixteen medical centers from North America reported data on adult HSCT recipients with proven or probable IFI during the period July 2004 through September 2007. The distribution of IFIs and rates of survival at 6 and 12 weeks after diagnosis were studied. We used logistic regression models to determine risk factors associated with 6-week mortality for allogeneic HSCT recipients with invasive aspergillosis (IA). Results. Two hundred thirty-four adult HSCT recipients with a total of 250 IFIs were included in this study. IA (59.2%) was the most frequent IFI, followed by invasive candidiasis (24.8%), zygomycosis (7.2%), and IFI due to other molds (6.8%). Voriconazole was the most frequently administered agent (68.4%); amphotericin B deoxycholate was administered to a few patients (2.1%). Ninety-three (46.7%) of 199 HSCT recipients with known outcome had died by week 12. The 6-week survival rate was significantly greater for patients with IA than for those with invasive candidiasis and for those with IFI due to the Zygomycetes or other molds (P < .001). The 6-week mortality rate for HSCT recipients with IA was 21.5%. At 6 weeks, there was a trend toward a worse outcome among allogeneic HSCT recipients with IA who received myeloablative conditioning (P = .07); absence of mechanical ventilation or/and hemodialysis (P = .01) were associated with improved survival. Conclusions. IA remains the most commonly identified IFI among HSCT recipients, but rates of survival in persons with IA appear to have improved, compared with previously reported data. Invasive candidiasis and IFI due to molds other than Aspergillus species remain a significant problem in HSCT recipients.
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U2 - 10.1086/595846
DO - 10.1086/595846
M3 - Article
C2 - 19115967
AN - SCOPUS:58749083534
SN - 1058-4838
VL - 48
SP - 265
EP - 273
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 3
ER -