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Variables predicting deep fungal infections in bone marrow transplant recipients
J Tollemar1, O Ringdén, L Boström
1Department of Clinical Immunology, Karolinska Institute, Huddinge Hospital, Sweden.
Abstract:
Deep fungal infections (FI) were diagnosed in 27 out of 209 consecutive bone marrow transplantation (BMT) recipients. Autopsy verified that the incidence of deep FI was 10% and the overall incidence was 13%. Using bivariate logistic regression analysis at the time of BMT, high recipient age (p = 0.003), low bone marrow cell dose (p = 0.007), recipient cytomegalovirus (CMV) seropositivity (p = 0.009) and splenectomy (p = 0.03) were significant risk factors for deep FI. In multivariate analysis, splenectomy (p = 0.008), recipient CMV seropositivity (p = 0.01) and low bone marrow cell dose (p = 0.01) held as significant. At 30 days post-BMT anti-thymocyte globulin treatment (p = 0.0006) and graft-versus-host disease grade II-IV (p = 0.005) were significant risk variables in bivariate logistic regression analysis and Fisher's exact probability test. Patients with these risk factors are candidates for treatment with antifungal drugs when they suffer from leukopenia and unclear fever.
Insights
Deep fungal infections (FI) affect 13% of bone marrow transplant (BMT) recipients. Key risk factors include older age, low cell dose, CMV seropositivity, splenectomy, and GVHD, guiding antifungal treatment decisions.
Area of Science:
- Hematology
- Infectious Diseases
- Transplantation Medicine
Background:
- Deep fungal infections (FI) are a significant complication following bone marrow transplantation (BMT).
- Identifying risk factors is crucial for timely diagnosis and management of FI in BMT recipients.
Purpose of the Study:
- To determine the incidence of deep fungal infections in bone marrow transplantation recipients.
- To identify significant risk factors associated with deep fungal infections post-BMT.
Main Methods:
- Retrospective analysis of 209 consecutive bone marrow transplantation recipients.
- Bivariate and multivariate logistic regression analyses were used to identify risk factors.
- Fisher's exact probability test was employed for specific post-transplant variables.
Main Results:
- The incidence of deep FI was 10% by autopsy and 13% overall.
- Significant pre-transplant risk factors included high recipient age, low bone marrow cell dose, CMV seropositivity, and splenectomy.
- Post-transplant risk factors identified were anti-thymocyte globulin treatment and graft-versus-host disease (GVHD) grade II-IV.
Conclusions:
- Older recipient age, low bone marrow cell dose, CMV seropositivity, splenectomy, ATG treatment, and GVHD are significant risk factors for deep FI post-BMT.
- Patients with identified risk factors experiencing leukopenia and fever should be considered for antifungal therapy.