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Induction of Alloantigen-specific Anergy in Human Peripheral Blood Mononuclear Cells by Alloantigen Stimulation with Co-stimulatory Signal Blockade
Published on: March 14, 2011
Successful allogeneic transplantation of patients with suspected prior invasive mold infection
Brian T Hill1, Lavayna Kondapalli, Andrew Artz
1Department of Internal Medicine, Cancer Research Center, University of Chicago, IL, USA.
Abstract:
Prior invasive fungal infection (IFI) has historically limited the use of allogeneic stem cell transplantation for patients with hematologic malignancies. Transplantation of such patients frequently resulted in recurrent infection and high mortality rates. Several new antifungal agents have been introduced over the past 5 years with broader spectra of activity against molds such as Aspergillus and a favorable toxicity profile. In this study, we present a series of 16 consecutive patients with hematologic malignancy and prior invasive fungal infection who underwent allogeneic transplantation. Of these patients, the majority of whom were treated with voriconazole and/or caspofungin, only four experienced recurrent fungal infection and recurrent fungal infection was the primary cause of death in only one patient. The estimated 45% 2-year survival in this series is similar to that for other patients with high risk hematologic malignancy undergoing stem cell transplantation. We conclude that suspected prior invasive fungal infection should not preclude the use of allogeneic stem cell transplantation.
Insights
Prior invasive fungal infection (IFI) no longer bars allogeneic stem cell transplants for hematologic malignancy patients. New antifungals like voriconazole and caspofungin improve outcomes, allowing more patients to undergo transplantation safely.
Area of Science:
- Hematology
- Mycology
- Transplantation Medicine
Background:
- Prior invasive fungal infection (IFI) historically contraindicates allogeneic stem cell transplantation (ASCT) in hematologic malignancy patients.
- ASCT in patients with a history of IFI was associated with high rates of recurrent infection and mortality.
- Recent advancements include new broad-spectrum antifungal agents with improved safety profiles.
Purpose of the Study:
- To evaluate the safety and efficacy of ASCT in hematologic malignancy patients with a history of IFI.
- To assess the impact of modern antifungal therapies on outcomes in this high-risk patient population.
Main Methods:
- Retrospective analysis of 16 consecutive patients with hematologic malignancy and prior IFI who underwent ASCT.
- Patients were predominantly treated with voriconazole and/or caspofungin for antifungal prophylaxis or treatment.
- Outcomes including recurrent fungal infection and survival were assessed.
Main Results:
- Only four out of 16 patients experienced recurrent fungal infection post-ASCT.
- Recurrent fungal infection was the primary cause of death in only one patient.
- The estimated 2-year survival rate was 45%, comparable to high-risk ASCT cohorts.
Conclusions:
- Suspected prior invasive fungal infection should not be an absolute contraindication for ASCT in patients with hematologic malignancies.
- Modern antifungal agents enable successful transplantation in patients with a history of IFI.
- ASCT is a viable option for selected patients with hematologic malignancies and prior IFI.
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