Evaluation of Risk Factors for Invasive Fungal Infection After Allogeneic Stem Cell Transplantation in Pediatric Patients

Abstract

Invasive fungal infections (IFIs) are a significant cause of morbidity and mortality after stem cell transplantation (SCT). The incidence, outcome, and risk factors for IFI after allogeneic SCT were analyzed in 149 pediatric patients treated at Hokkaido University hospital from 1988 to 2006. The cumulative incidence of IFI after allogeneic SCT was 8.1%; this comprised cases of proven, probable, and possible IFI at rates of 0.7%, 4.0%, and 3.4%, respectively. Only 1 patient complicated with IFI in the 100 days after SCT, excluding cases with rejection. Antifungal drugs were effective in 3 of the 12 patients with IFI, but the other 9 patients died because of IFI and relapse of original diseases. Nonrelapse mortality was markedly higher for patients with IFI than for those without IFI (60.0% vs. 20.0%, P=0.0204). Univariate analysis showed that age at transplant, chronic graft-versus-host disease (GVHD), and a corticosteroid dose >2 mg/kg or 60 mg/d for 10 days or longer were possible risk factors for IFI. Of these factors, chronic GVHD was the only factor associated with IFI in a multivariate analysis. Treatment of IFI is very difficult and, therefore, prevention of this condition is important, especially upon occurrence of chronic GVHD.