Prospective Surveillance for Invasive Fungal Infections in Hematopoietic Stem Cell Transplant Recipients, 2001–2006: Overview of the Transplant‐Associated Infection Surveillance Network (TRANSNET) Database

TLDR

The Transplant‑Associated Infections Surveillance Network prospectively enrolled HSCT recipients with proven and probable IFIs from 2001‑2006 to provide national incidence data, addressing gaps from single‑institution retrospective studies and informing improved management strategies. Denominator data for all HSCTs and detailed clinical, diagnostic, and outcome data for each IFI were collected across 23 centers, enabling calculation of 12‑month cumulative incidence in nine sequential subcohorts and identification of 983 IFIs among 875 recipients (718 IFIs in 639 of 16,200 first‑time transplants). Among 875 HSCT recipients with 983 IFIs, median age was 49 years, 60 % were male, invasive aspergillosis (43 %), candidiasis (28 %), and zygomycosis (8 %) were most common; 59 % and 61 % of IFIs were recognized within 60 days of neutropenia and graft‑versus‑host disease, respectively, with median onset of 61 days for candidiasis and 99 days for aspergillosis, and cumulative incidence was 7.7/100 for matched unrelated allogeneic, 8.1/100 for mismatched‑related allogeneic, 5.8/100 for matched‑related allogeneic, and 1.2/100 for autologous HSCT, with aspergillosis highest.

Abstract

The incidence and epidemiology of invasive fungal infections (IFIs), a leading cause of death among hematopoeitic stem cell transplant (HSCT) recipients, are derived mainly from single-institution retrospective studies.The Transplant Associated Infections Surveillance Network, a network of 23 US transplant centers, prospectively enrolled HSCT recipients with proven and probable IFIs occurring between March 2001 and March 2006. We collected denominator data on all HSCTs preformed at each site and clinical, diagnostic, and outcome information for each IFI case. To estimate trends in IFI, we calculated the 12-month cumulative incidence among 9 sequential subcohorts.We identified 983 IFIs among 875 HSCT recipients. The median age of the patients was 49 years; 60% were male. Invasive aspergillosis (43%), invasive candidiasis (28%), and zygomycosis (8%) were the most common IFIs. Fifty-nine percent and 61% of IFIs were recognized within 60 days of neutropenia and graft-versus-host disease, respectively. Median onset of candidiasis and aspergillosis after HSCT was 61 days and 99 days, respectively. Within a cohort of 16,200 HSCT recipients who received their first transplants between March 2001 and September 2005 and were followed up through March 2006, we identified 718 IFIs in 639 persons. Twelve-month cumulative incidences, based on the first IFI, were 7.7 cases per 100 transplants for matched unrelated allogeneic, 8.1 cases per 100 transplants for mismatched-related allogeneic, 5.8 cases per 100 transplants for matched-related allogeneic, and 1.2 cases per 100 transplants for autologous HSCT.In this national prospective surveillance study of IFIs in HSCT recipients, the cumulative incidence was highest for aspergillosis, followed by candidiasis. Understanding the epidemiologic trends and burden of IFIs may lead to improved management strategies and study design.