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Published on: July 1, 2020
Delphi-based study and analysis of key risk factors for invasive fungal infection in haematological patients
L Vázquez, M Salavert1, J Gayoso
1Miguel Salavert, Unit of Infectious Diseases, Hospital Universitario y Politécnico La Fe Av. Fernando Abril Martorell 106, E-46026 Valencia, Spain. salavert_mig@gva.es.
Objective:
Mortality caused by invasive fungal infections due to filamentous fungi (IFI-FF) is high. Predisposing factors to IFI-FF are multiple and should be stratified. The objective of this study was to identify key risk factors for IFI-FF in onco-haematological patients in different clinical settings.
Methods:
Prospective national Delphi study. Risk factors for IFI-FF in patients with onco-haematological diseases were identified by a systematic review of the literature. An anonymous survey was sent by e-mail to a panel of experts. A key risk factor was defined when at least 70% of the surveyed participants assigned a "maximal" or "high" risk.
Results:
In allogenic stem cell transplantation, 18 of the 42 risk factors analyzed were classified as key risk factors, including neutropenia, previous IFI-FF, grade III/IV acute or extensive chronic graft-versus-host disease (GVHD), umbilical cord blood transplantation, HLA mismatching transplantation, graft failure, absence of HEPA filters, absence of laminar air flow, diagnosis of acute myeloid leukaemia, haploidentical transplantation, anti-TNF-α drugs, alemtuzumab, anti-thymocyte globulin, immunosuppressive prophylaxis for GVHD, lymphocytopenia, cytomegalovirus infection, and proximity to construction areas. In acute leukaemia/myelodysplastic syndrome (AL/MDS), 7 of 25 risk factors were defined as key risk factors, including neutropenia, consolidation therapy without response, induction therapy, antifungal prophylaxis with azoles, proximity to construction areas, and absence of HEPA filters. In lymphoma/multiple myeloma (MM), the five key risk factors among 21 analyzed were use of steroids, neutropenia, progressive disease, anti-CD52 therapies, and proximity to construction areas.
Conclusions:
The Delphi method was useful for the classification and stratification of risk factors for IFI-FF in patients with onco-haematological diseases. Identifying key risk factors will contribute to a better management of IFI-FF in this group of patients at high or changing risk.
Insights
Identifying key risk factors for invasive fungal infections (IFI-FF) in onco-haematological patients is crucial for better management. This study stratified these risks across different clinical settings using the Delphi method.
Area of Science:
- Oncology
- Infectious Diseases
- Hematology
Background:
- Invasive fungal infections due to filamentous fungi (IFI-FF) carry a high mortality rate in onco-haematological patients.
- Multiple predisposing factors contribute to IFI-FF, necessitating stratification for effective management.
Purpose of the Study:
- To identify and stratify key risk factors for IFI-FF in patients undergoing onco-haematological treatments.
- To provide a basis for improved clinical management strategies.
Main Methods:
- A prospective national Delphi study was conducted.
- Risk factors were identified through a systematic literature review.
- An expert panel anonymously surveyed to define key risk factors (≥70% agreement on maximal/high risk).
Main Results:
- In allogeneic stem cell transplantation, 18 key risk factors were identified, including neutropenia, graft-versus-host disease (GVHD), and specific immunosuppressive agents.
- For acute leukaemia/myelodysplastic syndrome (AL/MDS), 7 key risk factors were identified, such as neutropenia, induction therapy, and antifungal prophylaxis.
- In lymphoma/multiple myeloma (MM), 5 key risk factors were identified, including steroid use, neutropenia, and progressive disease.
Conclusions:
- The Delphi method effectively classified and stratified IFI-FF risk factors in onco-haematological patients.
- Identification of these key risk factors will enhance the management of IFI-FF in this high-risk population.
