[Invasive mycoses during hematopoietic stem cell transplantation]

Area of Science:

• Hematology
• Infectious Diseases
• Mycology

Context:

• Hematopoietic stem cell transplantation (HSCT) is a critical treatment for various hematologic malignancies.
• Patients undergoing HSCT are at increased risk of invasive mycoses (IM), a serious complication.
• Understanding the epidemiology and risk factors of IM post-HSCT is crucial for improving patient outcomes.

Purpose:

• To determine the incidence, causes, and risk factors of invasive mycoses (IM) in patients undergoing allogeneic (allo) and autologous (auto) hematopoietic stem cell transplantation (HSCT).
• To assess the impact of IM on overall survival (OS) in HSCT recipients.

Summary:

• A retrospective analysis of 356 HSCT patients (2000-2010) revealed an IM incidence of 19.1%, significantly higher in allo-HSCT (23.2%) than auto-HSCT (10.9%).
• Aspergillus spp. was the most common pathogen (82.3%). Risk factors included acute lymphoblastic leukemia, non-myeloablative conditioning, specific immunosuppressive agents, peripheral blood stem cells, prolonged cytopenias, G-CSF use, graft-versus-host disease, and mucositis.
• Despite IM, one-year OS was not significantly affected, suggesting effective early diagnosis and treatment. However, invasive candidiasis, zygomycosis, and cryptococcosis carried a poor prognosis.

Impact:

• The study highlights the higher burden of IM in allo-HSCT and identifies key risk factors, including G-CSF, necessitating targeted preventive strategies.
• The findings underscore the importance of prompt IM diagnosis and treatment, as it did not adversely affect short-term survival.
• Further research is warranted to elucidate the reasons for high IM morbidity and to refine management protocols globally.