Analysis of Factors Influencing Skin Toxicity after Autologous Hematopoeitic Stem Cell Transplant.

Abstract Skin toxicity is a known but understudied complication of autologous stem cell transplantation (ASCT). Its assessment is complicated by the development of graft-vs-host disease following allogeneic transplantation. We chose therefore to study skin toxicity following autologous transplantation. We retrospectively reviewed the records of 392 patients undergoing ASCT to analyze risk factors for skin toxicity, its association with mucositis and its effect on survival. Skin toxicity was assessed three times a week during the transplant admission and was classified as none, mild, moderate, severe or life threatening. The most severe skin toxicity is used in this analysis. Mucositis was assessed using the modified oral mucositis assessment scale (OMAS). Median patient age was 53 years; 63% of patients had non-Hodgkin s lymphoma (NHL), 17.6% multiple myeloma, 13.5% Hodgkin disease (HD) and 5.9% acute leukemia. Peripheral blood progenitor cells were mobilized with G-CSF alone (36%) or the combination of etoposide plus G-CSF (64%). The preparative regimen was busulfan (Bu)/cyclophosphamide (Cy) /etoposide in 82% and Bu/Cy alone in 18%. Two hundred and sixty patients (67%) developed skin toxicity of which 143 patients (36.5%) had mild, 105 (26.8%) had moderate and 16 (3.9%) had severe skin toxicity. Factors associated with the development of any skin toxicity in univariable analysis were male gender (p=0.028), diagnosis of NHL (p<0.001) or HD (p=0.001), higher number of prior chemotherapy regimens (p<0.001), mobilization regimen containing etoposide (p< 0.001) and ASCT preparative regimen containing etoposide (p<0.001). Moderate skin toxicity correlated with the above as well. Only the inclusion of etoposide in the mobilization regimen was associated with an increased risk of severe skin toxicity (p=0.035). Etoposide in the preparative regimen remained the most significant risk factor for the development of skin toxicity in multivariable analysis. Higher OMAS score was associated with increased severity of skin toxicity (p<0.001) as shown in the boxplot below: Patients with severe skin toxicity appeared to have worse overall survival (p=0.054) and relapse-free survival (p=0.08), but these findings did not reach statistical significance. Conclusion: A substantial proportion of patients develop skin toxicity following autotransplantation. The inclusion of etoposide in the preparative regimen is associated with a significant increased frequency in multivariable analysis. The severity of skin toxicity correlates closely with the severity of mucositis. Figure Figure

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Unrelated Donor Stem Cell Transplantation for 36 Patients(pts) with Fanconi Anemia(FA): A Single Center Experience.

Blood ◽

10.1182/blood.v104.11.5171.5171 ◽

2004 ◽

Vol 104 (11) ◽

pp. 5171-5171

Author(s):

Carmem M.S. Bonfim ◽

Marco A. Bitencourt ◽

Daniela C. Setubal ◽

Vaneuza A. Funke ◽

Carlos R. deMedeiros ◽

...

Keyword(s):

Stem Cell ◽

Cord Blood ◽

Median Time ◽

Stem Cell Transplant ◽

Statistical Significance ◽

Effective Control ◽

Cell Transplant ◽

Increased Risk ◽

Grade Iii ◽

Related Mortality

Abstract Introduction: FA is an autossomal recessive syndrome that usually presents with congenital abnormalities, progressive pancytopenia and an increased risk of cancer.The first stem cell transplant for FA was performed in Latin America in 1983 and since then the BMT center from Curitiba, Brazil became a reference center for this disease. From 1983 until June 2004, 140 pts received a stem cell transplant for FA and most of them were in aplastic phase. In this study we performed a retrospective analysis of 36 patients who received an unrelated stem cell transplant for FA in our BMT center. Patients and methods: Period: 04/1996 to 06/2004, age 4 to 19 year old (median: 9y), sex: 20F/16M. Disease duration: 7 to 122 months (Median: 45), Previous transfusions: 0 to 400 (Median of 21). Aplastic phase: 35 pts. Myelodysplastic syndrome:1pt.Stem cell source : bone marrow 15 pts ( 6/6 : 12pts; 5/6 : 3pts) , cord blood : 20 pts ( 6/6: 3pts , 5/6 :8 pts and 4/6 : 9 pts) and peripheral stem cell : 1 pt ( 6/6). Preparatory regimen: 9 pts received only Cyclophosphamide (CY), 15 pts received CY + Fludarabine + Thimoglobuline, 4 pts received Fludarabine + TBI (200cGy), 4 pts received CY+ TBI ± ATG and 4 pts Fludarabine + CY. GVHD prophylaxis: Cyclosporine (Csa) + MTX: 18 pts, Csa + steroids: 14 pts and other: 4pts. All pts received prophylactic antibiotics according to common practice. Results: 13 pts are alive and well 45 to 1579 days after transplant (median 303 days). 34 pts were evaluable for engraftment (2 pts died before day 28 due to bacterial sepsis and CNS hemorrhage). Median time to reach PMN> 500/uL was 21 days after transplant (+ 12 to + 57) and platelets> 20.000/uL was 22, 5 days (+14 to + 49). Pts who received CY + Fludarabine + Thimoglobuline had a better survival (56%) but it did not reach statistical significance when compared to other preparatory regimens. Acute graft versus host disease (A-GVHD) occurred in 9 pts (grade III: 4 pts, grade IV: 5 pts). Three pts with grade III A-GVHD developed C-GVHD (2 were extensive and severe). VOD was diagnosed in 3 pts (moderate/severe). Mucosytis grade III- IV occurred in 16 pts. Twenty-three pts died at a median time of 58 days after transplant (7 to 226 d). All pts with primary graft failure (11) and 5 pts with only a neuthrophil engraftment died. Causes of death: 15 pts: infections or hemorrhage related to rejection; 4 pts: GVHD, 3 pts:VOD , 1 pt: P carinii and 1 pt EBV lymphoproliferative disease. Transplant related mortality (TRM) was 55% for the whole group (38% for the pts who received CY+ Fludarabine + ATG). It was also lower (35%) for the pts who received cord blood transplants but it did not reach statistical significance regarding survival rate. Conclusions: Treatment of FA pts with unrelated stem cell transplant must be directed at a more effective control of rejection and GVHD. Transplant related mortality is still very high in this group of pts. Our study shows that the use of CY + Fludarabine + Thimoglobuline may improve survival but we still need more pts and a longer follow up to confirm this data.

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Prior gemtuzumab ozogamicin exposure significantly increases the risk of veno-occlusive disease in patients who undergo myeloablative allogeneic stem cell transplantation

Blood ◽

10.1182/blood-2003-01-0255 ◽

2003 ◽

Vol 102 (5) ◽

pp. 1578-1582 ◽

Cited By ~ 222

Author(s):

Martha Wadleigh ◽

Paul G. Richardson ◽

David Zahrieh ◽

Stephanie J. Lee ◽

Corey Cutler ◽

...

Keyword(s):

Stem Cell ◽

Short Interval ◽

Significant Risk ◽

Disease Status ◽

Significant Risk Factor ◽

Gemtuzumab Ozogamicin ◽

Myelogenous Leukemia ◽

Increased Risk ◽

Acute Myelogenous ◽

Previously Treated

AbstractGemtuzumab ozogamicin (GO), a monoclonal antibody used in the treatment of acute myelogenous leukemia (AML) has been linked to the development of venoocclusive disease (VOD). We conducted a retrospective study of 62 patients with previously treated AML/MDS (myelodysplastic syndrome) who underwent allogeneic stem cell (SC) transplantation at our institution from December 2000 to October 2002 to determine whether GO exposure prior to allogeneic SC transplantation increases the risk of developing VOD. Fourteen patients received GO prior to SC transplantation. Of 62 patients, 13 (21%) developed VOD; 9 (64%) of 14 with prior GO exposure developed VOD compared with 4 (8%) of 48 without prior GO exposure (P < .0001). Logistic regression controlling for sex, disease status, donor type, and graft-versus-host disease prophylaxis identified prior treatment with GO as a significant risk factor for VOD (odds ratio [OR], 21.6; 95% confidence interval [CI], 4.2-112.2]. Nine of 10 patients who underwent SC transplantation 3.5 months or less following GO developed VOD compared with none of 4 patients who underwent SC transplantation more than 3.5 months from GO administration. Three of 14 patients who received GO prior to SC transplantation died of VOD. We conclude that patients undergoing SC transplantation within a short interval from GO administration are at increased risk of developing VOD.

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High plasma levels of soluble P-selectin are predictive of venous thromboembolism in cancer patients: results from the Vienna Cancer and Thrombosis Study (CATS)

Blood ◽

10.1182/blood-2008-02-142422 ◽

2008 ◽

Vol 112 (7) ◽

pp. 2703-2708 ◽

Cited By ~ 236

Author(s):

Cihan Ay ◽

Ralph Simanek ◽

Rainer Vormittag ◽

Daniela Dunkler ◽

Guelay Alguel ◽

...

Keyword(s):

Risk Factor ◽

Venous Thromboembolism ◽

Cancer Patients ◽

Plasma Levels ◽

Multivariable Analysis ◽

Significant Risk ◽

Significant Risk Factor ◽

Cumulative Probability ◽

Increased Risk ◽

Soluble P

Abstract Cancer patients are at high risk for venous thromboembolism (VTE). Laboratory parameters with a predictive value for VTE could help stratify patients into high- or low-risk groups. The cell adhesion molecule P-selectin was recently identified as risk factor for VTE. To investigate soluble P-selectin (sP-selectin) in cancer patients as risk predictor for VTE, we performed a prospective cohort study of 687 cancer patients and followed them for a median (IQR) of 415 (221-722) days. Main tumor entities were malignancies of the breast (n = 125), lung (n = 86), gastrointestinal tract (n = 130), pancreas (n = 42), kidney (n = 19), prostate (n = 72), and brain (n = 80); 91 had hematologic malignancies; 42 had other tumors. VTE occurred in 44 (6.4%) patients. In multivariable analysis, elevated sP-selectin (cutoff level, 53.1 ng/mL, 75th percentile of study population) was a statistically significant risk factor for VTE after adjustment for age, sex, surgery, chemotherapy, and radiotherapy (hazard ratio = 2.6, 95% confidence interval, 1.4-4.9, P = .003). The cumulative probability of VTE after 6 months was 11.9% in patients with sP-selectin above and 3.7% in those below the 75th percentile (P = .002). High sP-selectin plasma levels independently predict VTE in cancer patients. Measurement of sP-selectin at diagnosis of cancer could help identify patients at increased risk for VTE.

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Outcomes of Cytomegalovirus Monitoring in Autologous Transplantation: A Single Institution Experience

Blood ◽

10.1182/blood-2021-147499 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 3949-3949

Author(s):

Mark Fesler ◽

Mackenzie J Poole ◽

Linda Goldenberg ◽

Alexis Guennette ◽

Kara J Christopher

Keyword(s):

Stem Cell ◽

Autologous Transplantation ◽

Screening Tests ◽

Cell Transplant ◽

Post Transplant ◽

Autologous Transplant ◽

Preparative Regimen ◽

Cmv Disease ◽

Dna Pcr ◽

Cmv Reactivation

Abstract Introduction: Identification of patients seropositive for cytomegalovirus (CMV) prior to stem cell transplant (SCT) is a well-accepted practice across institutions designed to reduce a known cause of morbidity and mortality in this population, but the role of monitoring and preemptive approaches to CMV identification and treatment are controversial and not standardized in autologous transplantation. The preemptive approach necessitates the use of significant resources and requires persistent patient involvement. Patients undergoing autologous SCT are at a relatively low risk for CMV reactivation, especially those seronegative for CMV at the time of transplant. Here, we show that the necessity of routine monitoring of autologous transplant patients is of minimal clinical value. Methods: To determine the efficacy of the CMV monitoring protocol currently in place at our institution in detecting patients who would later develop CMV reactivation and disease following autologous SCT, we retrospectively analyzed the charts of 218 adult patients between 11/1/14 and 8/1/19 who underwent transplant at St. Louis University Hospital. No patients underwent CD34 selected stem cell infusions. The protocol stipulated the following: CMV IgG/IgM and CMV DNA PCR prior to preparative regimen followed by weekly CMV DNA PCR to day +30 . We correlated the predictive ability of positive results on any of these screening tests to identify whether patients would later develop quantifiable CMV DNA PCR positivity, clinical manifestations of CMV disease, and/or require pharmacologic treatment for CMV. Results: Quantifiable pre-BMT DNA PCR was positive in only 0.46% of patients, and 97.79% of patients were DNA PCR negative prior to transplant. CMV IgG was positive in 56.4% patients, and only 22.1% of patients in this group went on to develop a quantifiable post-transplant PCR. Of the remaining 43.6% of patients initially testing negative for CMV IgG, no patients went on to develop a quantifiably positive post-transplant PCR. Regardless of seropositivity, only 0.08% of the 1,191 PCRs performed during the study period were found to be quantifiable. Further, no patients in our cohort developed CMV disease or required CMV treatment during the monitoring period. This trend persisted despite stratification by age, diagnosis, transplant number, and preparative regimen. Conclusion: When clinically-significant CMV is defined by cases requiring treatment or the development of end-organ disease, no screening tests performed elicited clinical action. Laboratory-based CMV surveillance, based on our data, has minimal diagnostic implications and represents an overly-stringent practice in a set of patients already utilizing a substantial share of healthcare resources. We believe that pre-transplant screening for CMV IgM serology and CMV DNA PCR can be safely eliminated in the autologous SCT population at our institution while CMV IgG still plays a role in determining candidacy for CMV-negative blood products. We also propose the elimination of serial post-transplant monitoring with DNA PCR in patients without clinical signs, symptoms, or pathologic findings suggestive of CMV disease. We have changed the protocol to test for CMV PCR only if there are clinical scenarios that indicate a utility, such as prolonged fever post-transplant, unexplained cytopenias, or unexplained pneumonitis, colitis, or hepatitis. By extension, other centers should consider determining the necessity of CMV screening in their autologous transplant population given the potential resource conservation and reduction in healthcare expenditures. Disclosures Fesler: abbvie: Consultancy, Speakers Bureau; incyte: Consultancy, Speakers Bureau; sanofi: Speakers Bureau; morphosys: Speakers Bureau; epizyme: Consultancy; jazz: Consultancy; Skipta: Consultancy; Best Doctors: Consultancy; Aptitude Health: Consultancy; Care Dx: Consultancy; Opinionsite: Consultancy. Goldenberg: Seattle Genetics: Membership on an entity's Board of Directors or advisory committees.

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Physical Illness and Suicide Risk in Rural Residents of Contemporary China

Crisis ◽

10.1027/0227-5910/a000271 ◽

2014 ◽

Vol 35 (5) ◽

pp. 330-337 ◽

Cited By ~ 14

Author(s):

Cun-Xian Jia ◽

Lin-Lin Wang ◽

Ai-Qiang Xu ◽

Ai-Ying Dai ◽

Ping Qin

Keyword(s):

Risk Factor ◽

Family Income ◽

Rural China ◽

Significant Risk ◽

Significant Risk Factor ◽

Health Condition ◽

Physical Illness ◽

Rural Residents ◽

Increased Risk ◽

Study Population

Background: Physical illness is linked with an increased risk of suicide; however, evidence from China is limited. Aims: To assess the influence of physical illness on risk of suicide among rural residents of China, and to examine the differences in the characteristics of people completing suicide with physical illness from those without physical illness. Method: In all, 200 suicide cases and 200 control subjects, 1:1 pair-matched on sex and age, were included from 25 townships of three randomly selected counties in Shandong Province, China. One informant for each suicide or control subject was interviewed to collect data on the physical health condition and psychological and sociodemographic status. Results: The prevalence of physical illness in suicide cases (63.0%) was significantly higher than that in paired controls (41.0%; χ2 = 19.39, p < .001). Compared with suicide cases without physical illness, people who were physically ill and completed suicide were generally older, less educated, had lower family income, and reported a mental disorder less often. Physical illness denoted a significant risk factor for suicide with an associated odds ratio of 3.23 (95% CI: 1.85–5.62) after adjusted for important covariates. The elevated risk of suicide increased progressively with the number of comorbid illnesses. Cancer, stroke, and a group of illnesses comprising dementia, hemiplegia, and encephalatrophy had a particularly strong effect among the commonly reported diagnoses in this study population. Conclusion: Physical illness is an important risk factor for suicide in rural residents of China. Efforts for suicide prevention are needed and should be integrated with national strategies of health care in rural China.

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Post-thyroidectomy bleeding: analysis of risk factors from a national registry

British Journal of Surgery ◽

10.1093/bjs/znab015 ◽

2021 ◽

Author(s):

H E Doran ◽

S M Wiseman ◽

F F Palazzo ◽

D Chadwick ◽

S Aspinall

Keyword(s):

Risk Factors ◽

Total Thyroidectomy ◽

Thyroid Surgery ◽

Multivariable Analysis ◽

Significant Risk ◽

Bleeding Risk ◽

Redo Surgery ◽

Day Case ◽

Increased Risk ◽

Male Sex

Abstract Background Post-thyroidectomy haemorrhage occurs in 1–2 per cent of patients, one-quarter requiring bedside clot evacuation. Owing to the risk of life-threatening haemorrhage, previous British Association of Endocrine and Thyroid Surgeons (BAETS) guidance has been that day-case thyroidectomy could not be endorsed. This study aimed to review the best currently available UK data to evaluate a recent change in this recommendation. Methods The UK Registry of Endocrine and Thyroid Surgery was analysed to determine the incidence of and risk factors for post-thyroidectomy haemorrhage from 2004 to 2018. Results Reoperation for bleeding occurred in 1.2 per cent (449 of 39 014) of all thyroidectomies. In multivariable analysis male sex, increasing age, redo surgery, retrosternal goitre and total thyroidectomy were significantly correlated with an increased risk of reoperation for bleeding, and surgeon monthly thyroidectomy rate correlated with a decreased risk. Estimation of variation in bleeding risk from these predictors gave low pseudo-R2 values, suggesting that bleeding is unpredictable. Reoperation for bleeding occurred in 0.9 per cent (217 of 24 700) of hemithyroidectomies, with male sex, increasing age, decreasing surgeon volume and redo surgery being risk factors. The mortality rate following thyroidectomy was 0.1 per cent (23 of 38 740). In a multivariable model including reoperation for bleeding node dissection and age were significant risk factors for mortality. Conclusion The highest risk for bleeding occurred following total thyroidectomy in men, but overall bleeding was unpredictable. In hemithyroidectomy increasing surgeon thyroidectomy volume reduces bleeding risk. This analysis supports the revised BAETS recommendation to restrict day-case thyroid surgery to hemithyroidectomy performed by high-volume surgeons, with caution in the elderly, men, patients with retrosternal goitres, and those undergoing redo surgery.

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Bone and Joint Infections among Hematopoietic Stem Cell Transplant Recipients

Journal of Bone and Joint Infection ◽

10.7150/jbji.38120 ◽

2019 ◽

Vol 4 (5) ◽

pp. 209-215

Author(s):

Cybele Lara Abad ◽

Vania Phuoc ◽

Prashant Kapoor ◽

Pritish K. Tosh ◽

Irene G. Sia ◽

...

Keyword(s):

Stem Cell ◽

Septic Arthritis ◽

Hematopoietic Stem Cell ◽

Joint Infection ◽

Cell Transplant ◽

Hematopoietic Stem ◽

Joint Infections ◽

Bone And Joint Infections ◽

Prosthetic Joint ◽

Increased Risk

Abstract. Background: Hematopoietic stem cell transplantation (HSCT) recipients are at increased risk for infection. This study describes bone and joint infections (BJI) among HSCT recipients.Methods: We reviewed 5861 patients who underwent HSCT at Mayo Clinic, Rochester, MN from January 1, 2005 through January 1, 2015 for study inclusion. BJI was defined as native septic arthritis, prosthetic joint infection, osteomyelitis, and orthopedic implant infection. All adults with BJI after HSCT were included in the analysis.Results: Of 5861 patients, 33 (0.6%) developed BJI. Native joint septic arthritis was the most common BJI occurring in 15/33 (45.4%) patients. Patients were predominantly male (24/33, 72.7%), with median age of 58 (range 20-72) years. BJI was diagnosed a median of 39 (range 1-114) months after allogeneic (14/33, 42.4%) or autologous (19/33, 57.6%) HSCT. Organisms were recovered via tissue (24/27, 88.9%), synovial fluid (13/17, 76.5%), and/or blood cultures (16/25, 64%). Most underwent surgical debridement (23/33, 69.7%). Patients were followed a median of 78.3 months (range 74-119). Therapy was unsuccessful in 4/33 (12.1%), with death related to the underlying BJI in two (50%). Failure occurred a median of 3.4 (0.1-48.5) months from diagnosis. At last follow up, 7/33 (21.2%) patients were alive. Median overall survival was 13 months (0.07-70.6).Conclusion: BJI among HSCT recipients is infrequent. The most common infection is native joint septic arthritis. Pathogens appear similar to patients without HSCT. Treatment involving surgical-medical modalities is successful, with most patients surviving >1 year after BJI.

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Hepatotoxicity during legacy cancer chemotherapy in patients infected with hepatitis C virus: A retrospective cohort study

Canadian Liver Journal ◽

10.3138/canlivj-2021-0018 ◽

2021 ◽

Author(s):

Jean-Luc Szpakowski ◽

Lue-Yen Tucker ◽

David M Baer ◽

Mary Pat Pauly

Keyword(s):

Risk Factor ◽

Hepatitis C Virus ◽

Hepatitis C ◽

Cancer Progression ◽

Cancer Chemotherapy ◽

Multivariable Analysis ◽

Significant Risk ◽

Significant Risk Factor ◽

Hcv Infection ◽

Grade 3

Background: The rates and causes of significant hepatotoxicity with cancer chemotherapy (CCT) in patients infected with hepatitis C virus (HCV) are incompletely characterized. Methods: We compared rates of grade 3 or 4 hepatotoxicity, defined as elevated transaminases, during CCT in patients who are mono-infected with HCV compared with rates in controls matched on demographics, diagnosis, and rituximab use. We excluded patients with hepatobiliary cancers, hepatitis B virus or human immunodeficiency virus infection. Hepatotoxicity was attributed to a medical cause, cancer progression, or CCT, including HCV flare. Results: Patients with HCV ( n = 196) had a higher rate of cirrhosis than the 1,130 matched controls (21.9% versus 4%; P <0.001). Their higher rate of overall hepatotoxicity (8.7% versus 4.5% of controls, P = 0.01 was due to higher rate of CCT-related hepatotoxicity (4.1% versus 1.2%, P = 0.01). On multivariable analysis, the largest risk factor for overall hepatotoxicity was cirrhosis, and the only risk factor for CCT-related hepatotoxicity was HCV infection. Among those with HCV, the only significant risk factor for hepatotoxicity was rituximab use. Hepatotoxicity caused by CCT delayed or altered treatment in only 3 HCV patients and 1 control (1.5% versus 0.1%, P = 0.01). Conclusions: Most patients with HCV can safely be treated with cancer chemotherapy. Cirrhosis and HCV infection contributed to increased hepatotoxicity in subjects on CCT. Among HCV patients, rituximab use was the major risk factor for increased hepatotoxicity. Hepatotoxicity due to CCT itself rarely altered or delayed CCT. Nonetheless, HCV-positive patients should be monitored carefully during CCT.

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Invasive aspergillosis in allogeneic stem cell transplant recipients: changes in epidemiology and risk factors

Blood ◽

10.1182/blood-2002-05-1496 ◽

2002 ◽

Vol 100 (13) ◽

pp. 4358-4366 ◽

Cited By ~ 668

Author(s):

Kieren A. Marr ◽

Rachel A. Carter ◽

Michael Boeckh ◽

Paul Martin ◽

Lawrence Corey

Keyword(s):

Risk Factors ◽

Stem Cell ◽

Invasive Aspergillosis ◽

Respiratory Virus ◽

Stem Cell Transplant ◽

Myelogenous Leukemia ◽

Cell Transplant ◽

Hematopoietic Stem ◽

Increased Risk ◽

Cmv Disease

The incidence of postengraftment invasive aspergillosis (IA) in hematopoietic stem cell transplant (HSCT) recipients increased during the 1990s. We determined risks for IA and outcomes among 1682 patients who received HSCTs between January 1993 and December 1998. Risk factors included host variables (age, underlying disease), transplant variables (stem cell source), and late complications (acute and chronic graft-versus-host disease [GVHD], receipt of corticosteroids, secondary neutropenia, cytomegalovirus [CMV] disease, and respiratory virus infection). We identified risk factors associated with IA early after transplantation (≤ 40 days) and after engraftment (41-180 days). Older patient age was associated with an increased risk during both periods. Chronic myelogenous leukemia (CML) in chronic phase was associated with low risk for early IA compared with other hematologic malignancies, aplastic anemia, and myelodysplastic syndrome. Multiple myeloma was associated with an increased risk for postengraftment IA. Use of human leukocyte antigen (HLA)–matched related (MR) peripheral blood stem cells conferred protection against early IA compared with use of MR bone marrow, but use of cord blood increased the risk of IA early after transplantation. Factors that increased risks for IA after engraftment included receipt of T cell–depleted or CD34-selected stem cell products, receipt of corticosteroids, neutropenia, lymphopenia, GVHD, CMV disease, and respiratory virus infections. Very late IA (> 6 months after transplantation) was associated with chronic GVHD and CMV disease. These results emphasize the postengraftment timing of IA; risk factor analyses verify previously recognized risk factors (GVHD, receipt of corticosteroids, and neutropenia) and uncover the roles of lymphopenia and viral infections in increasing the incidence of postengraftment IA in the 1990s.

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