Risk factors for invasive mold infections following allogeneic hematopoietic stem cell transplantation: A single center study of 190 recipients

Abstract

BACKGROUND: Invasive mold infection (IMI) is a major cause of infection-related mortality following allogeneic hematopoietic stem cell transplantation (allo-HSCT). METHODS: We retrospectively analyzed 190 allo-HSCT recipients at Changhai Hospital between the y 2000 and 2007. The survival rate was evaluated with Kaplan-Meier curves. Logistic and Cox regression models were used for multivariate analyses. RESULTS: The 1(st) y cumulative incidence rate of IMI was 12.8%, and invasive aspergillosis was the most commonly observed IMI (85%). Multivariate logistic regression analyses showed that significant predictors of IMI were corticosteroid therapy (odds ratio (OR) 1.656, 95% confidence interval (CI) 1.047-2.621, p = 0.031), positive cytomegalovirus antigenemia (OR 5.301, 95% CI 1.902-14.772, p = 0.001), and secondary neutropenia (OR 5.250, 95% CI 1.741-15.834, p = 0.003). The mortality rate of IMI at 12 weeks after diagnosis was 60%. In Cox regression models, IMI-related mortality was related to the dose of corticosteroid (2 mg/kg/day or more) administered at the time of IMI diagnosis (hazards ratio (HR) 20.841, 95% CI 2.151-201.944, p = 0.009) and neutropenia (HR 7.043, 95% CI 1.186-41.827, p = 0.032). CONCLUSIONS: These data confirm previous findings that the incidence and mortality of IMI are mostly associated with immunodeficiency caused by immunosuppressive therapy or virus infection.