Risk factors for invasive mold diseases in allogeneic hematopoietic cell transplant recipients

The epidemiology of and risk factors for invasive mold disease (IMD) among allogeneic hematopoietic cell transplant (HCT) recipients may vary according to the region. In this study, we sought to evaluate risk factors for IMD in our patient population.

Between May 2007 and July 2009, all HCT recipients from 8 Brazilian centers were followed prospectively until 1 year post transplant. Cases of IMD were classified as early (before day +40) or late (after day +40). Patients with IMD (cases) were compared with controls (patients without IMD) using univariate and multivariate Cox regression analysis.

Among 345 HCT recipients, 28 IMDs were diagnosed. Risk factors for early IMD were acute myeloid leukemia (hazard ratio [HR] 2.95, 95% confidence interval [95% CI] 1.13-7.68, P = 0.03) and transplant with a human leukocyte antigen-mismatched donor (HR 3.38, 95% CI 1.18-9.68, P = 0.02), and for late IMD risk factors were lymphoma (HR 8.49, 95% CI 2.35-30.68, P = 0.001), cytomegalovirus reactivation (HR 5.51, 95% CI 1.15-26.47, P = 0.03), and neutropenia (HR 3.49, 95% CI 1.01-12.13, P = 0.049).

The variables identified in this study may help to define risk groups, and to tailor special preventive measures to patients at higher risk to develop IMD.