Clinical features and analysis of risk factors for invasive candidal infection after marrow transplantation

¹Program in Infectious Disease, Fred Hutchinson Cancer Research Center, Seattle, WA 98104.

|October 1, 1991

Abstract:

Of 1506 marrow transplant patients from 1980 through 1986 reviewed for risk factors for invasive candidal infection defined by positive blood cultures, biopsy, or histologic evidence of tissue invasion, 171 (11.4%) had invasive infection, with a significantly higher incidence in the more recent years of review; 40% (69 patients) had evidence of tissue-invasive disease without fungemia. Of 102 patients with fungemia, 45% had candidemia alone with a mortality of 39%. Mortality in patients with tissue involvement was 90% with or without fungemia. Factors that increased infection were age, acute graft-versus-host disease, and donor mismatch. Factors that decreased infection included conditioning with 12 Gy of fractionated irradiation and cyclophosphamide, transplantation for aplastic anemia, and more rapid engraftment. Among fungemic patients, the number of days of fungemia was a risk factor for tissue invasion while more rapid engraftment was protective.

Insights

Invasive fungal infections, particularly candidiasis, pose a significant risk to marrow transplant patients. Early detection and understanding risk factors are crucial for improving outcomes in these vulnerable individuals.

Area of Science:

Hematology
Infectious Diseases
Oncology

Background:

Invasive fungal infections are a serious complication in hematopoietic stem cell transplant (HSCT) recipients.
Candida species are common causes of invasive fungal infections in immunocompromised patients.
Risk factors and outcomes of invasive candidal infections in HSCT patients require further elucidation.

Purpose of the Study:

To identify risk factors associated with invasive candidal infections in marrow transplant recipients.
To determine the incidence and mortality rates of invasive candidal infections.
To investigate the relationship between fungemia, tissue invasion, and patient outcomes.

Main Methods:

Retrospective review of 1506 marrow transplant patients from 1980-1986.
Inclusion criteria: positive blood cultures, biopsy, or histologic evidence of tissue invasion by Candida.
Analysis of patient demographics, transplant characteristics, and clinical outcomes.

Main Results:

11.4% of patients developed invasive candidal infection, with increasing incidence over time.
40% of infected patients had tissue invasion without fungemia.
Mortality was 39% for candidemia alone and 90% for tissue-invasive disease (with or without fungemia).
Risk factors for infection included advanced age, acute graft-versus-host disease, and donor mismatch.
Protective factors included specific conditioning regimens (irradiation and cyclophosphamide), transplantation for aplastic anemia, and rapid engraftment.

Conclusions:

Invasive candidal infections are associated with high mortality in marrow transplant recipients, especially with tissue involvement.
Age, graft-versus-host disease, and donor factors increase infection risk.
Specific conditioning, diagnosis, and rapid engraftment are protective.
Fungemia duration is a risk factor for tissue invasion, while rapid engraftment is protective.

Read full analysis

Related Experiment Videos

Clinical features and analysis of risk factors for invasive candidal infection after marrow transplantation

Insights

Related Concept Videos

Prenatal and childhood lead exposure is prospectively associated with biological markers of aging in adolescence.

Associations of prenatal and childhood Pb exposure with allostatic load in adolescence: Findings from the ELEMENT cohort study.

[Human herpesvirus-6 infection induces IL-10 production in monocytes].

Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease.

NCCN Practice Guidelines for Breast Cancer.

Active-control trials: how would a new agent compare with placebo? A method illustrated with clopidogrel, aspirin, and placebo.

Chlamydia trachomatis (CT) antibody-mediated opsonophagocytosis is not associated with reduced endometrial or incident infection.

Association of HPV16 E7-specific T cell responses in cervical lymphocytes and peripheral blood with regression of high-grade cervical intraepithelial neoplasia lesions.

Plasma Proteome Signature of Immune Inhibition is Associated with Cytomegalovirus in People with HIV-1.

Bronchoalveolar Lavage Fluid Cellularity Reflects Peripheral Cytopenias and Fungal Burden but Not Short-Term Outcomes in Invasive Pulmonary Aspergillosis.

Isavuconazole and Micafungin Elicit Synergistic Antifungal and Immunomodulatory Activity Against Azole-Resistant Aspergillus fumigatus.

Host Immune Biosignatures Predict Septic Shock and Mortality in Solid Organ Transplant Recipients With Gram-Negative Bacteremia.

Environmental contamination with fluorouracil on floors and ceilings in antineoplastic drug preparation and nonpreparation areas of a Japanese cancer center.

Exploiting Neosartorya (Aspergillus) fischeri antifungal protein 2-defined fungal targets for drug repurposing against Candida albicans.

Multi-omics elucidate octapeptin mechanisms in alleviating intestinal injury in mice challenged with ETEC K88 via modulated microbial and host pathways.

A phosphoinositide and RAB switch controls early macropinocytosis.

Adrenal Infections: An Underrecognized Cause of Primary Adrenal Insufficiency.

Mismatch Repair Pathway, MLH1, MSH2 and Mutations in Prostate Cancer.

Related Experiment Videos

Clinical features and analysis of risk factors for invasive candidal infection after marrow transplantation

Abstract:

Insights

Related Concept Videos

Related Articles