Impact of the intensity of the pretransplantation conditioning regimen in patients with prior invasive aspergillosis undergoing allogeneic hematopoietic stem cell transplantation: A retrospective survey of the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation

Rodrigo Martino, Rocio Parody, Takahiro Fukuda, Johan Maertens, Koen Theunissen, Aloysius Ho, Ghulam J. Mufti, Nicolaus Kroger, Arnold R. Zander, Dominik Heim, Monika Paluszewska, Dominik Selleslag, Katerina Steinerova, Per Ljungman, Simone Cesaro, Anna Nihtinen, Catherine Cordonnier, Lourdes Vazquez, Monica López-Duarte, Javier LopezRafael Cabrera, Montserrat Rovira, Stefan Neuburger, Oliver Cornely, Ann E. Hunter, Kieren A. Marr, Hans Jürgen Dornbusch, Hermann Einsele

Research output: Contribution to journalArticlepeer-review

Abstract

In this retrospective study, we analyzed the outcomes of 129 patients who underwent an allogeneic hematopoietic stem cell transplantation (allo-HSCT) and had a history of probable or proven invasive aspergillosis (IA), of whom 57 (44%) received a reduced-intensity conditioning (RIC). Overall, 27 patients with IA progressed after the allo-HSCT (cumulative incidence [CumInc] at 2 years, 22%). The variables that increased the 2-year CumInc of IA progression were (1) longer duration of neutropenia after transplantation; (2) advanced status of the underlying disease; and (3) less than 6 weeks from start of systemic anti-Aspergillus therapy and the allo-HSCT. In addition, (4) conventional myeloablative conditioning increased the risk of progression early after transplantation (before day 30) only, while 3 variables increased the risk beyond day 30 were (5) cytomegalovirus disease; (6) bone marrow or cord blood as source of stem cells; and (7) grades II to IV acute graft-versus-host disease (GVHD). A risk model for progression was generated, defined as low (0-1 risk factors, 6% incidence), intermediate (2-3 risk factors, 27% incidence), or high risk (≥ 3 risk factors, 72% incidence [P < .001]). These findings may help in the interpretation and design of future studies on secondary prophylaxis of IA after an allo-HSCT.

Original languageEnglish (US)
Pages (from-to)2928-2936
Number of pages9
JournalBlood
Volume108
Issue number9
DOIs
StatePublished - Nov 1 2006
Externally publishedYes

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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