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Aspergillus infections in bone marrow transplant recipients
J R Wingard1, S U Beals, G W Santos
1Bone Marrow Transplant Program, Johns Hopkins Oncology Center, Baltimore, MD.
Abstract:
Aspergillus infection was studied in patients admitted to the Bone Marrow Transplant (BMT) Service at the Johns Hopkins Oncology Center during a 9-year period. The overall incidence was 4% in 549 patients reviewed. The incidence at autopsy was 12% (21 of 174 patients autopsied). There was no difference in frequency of occurrence in allogeneic compared to autologous BMT recipients. However, all infections in autologous BMT patients (5 of 5) occurred during neutropenia before engraftment. In contrast, 16 of 17 infections in allogeneic BMT patients occurred after engraftment (p = 0.0002). This difference presumably related to differences in duration of neutropenia and immunodeficiency. Age, underlying disease, date of BMT, preparative regimen, remission status, prior treatment, interstitial pneumonitis and concomitant cytomegalovirus infection did not predispose patients to aspergillus infection. Different post-BMT immunosuppressive regimens did not affect the risk for aspergillus infection except that patients who were given cyclophosphamide plus methylprednisolone had a higher incidence of aspergillus infection than those given methotrexate (12% versus 1%, p = 0.03). Acute graft-versus-host disease imposed a slight risk for infection (p = 0.06).
Insights
Aspergillus infections occur in 4% of bone marrow transplant (BMT) patients. Allogeneic BMT recipients face higher risks post-engraftment, unlike autologous BMT patients who are vulnerable during neutropenia.
Area of Science:
- Medical Mycology
- Hematology
- Transplant Immunology
Background:
- Aspergillus infections pose a significant risk to immunocompromised patients, particularly those undergoing hematopoietic stem cell transplantation.
- Understanding the incidence and risk factors for Aspergillus infection post-BMT is crucial for patient management and outcomes.
Purpose of the Study:
- To investigate the incidence and risk factors of Aspergillus infection in patients undergoing bone marrow transplantation (BMT).
- To compare the occurrence of Aspergillus infection between allogeneic and autologous BMT recipients.
- To identify specific patient characteristics and treatment regimens associated with increased risk.
Main Methods:
- Retrospective review of 549 patients admitted to the Bone Marrow Transplant (BMT) Service over a 9-year period.
- Analysis of Aspergillus infection incidence, timing relative to engraftment, and correlation with patient demographics, disease status, and immunosuppressive regimens.
- Statistical comparison of infection rates between different BMT types and treatment protocols.
Main Results:
- Overall incidence of Aspergillus infection was 4% in BMT patients, rising to 12% at autopsy.
- No significant difference in frequency between allogeneic and autologous BMT recipients.
- Infections occurred post-engraftment in most allogeneic recipients (16/17) but pre-engraftment during neutropenia in all autologous recipients (5/5).
- Cyclophosphamide plus methylprednisolone regimen was associated with a higher incidence (12%) compared to methotrexate (1%).
- Acute graft-versus-host disease showed a slight increased risk (p=0.06).
Conclusions:
- Aspergillus infection incidence in BMT patients is significant, particularly noted at autopsy.
- The timing of Aspergillus infection differs between allogeneic and autologous BMT, likely due to variations in neutropenia duration and immunodeficiency.
- Certain immunosuppressive regimens and acute graft-versus-host disease may influence the risk of Aspergillus infection post-BMT.