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  • Title: Outcome of non-mold effective anti-fungal prophylaxis in patients at high-risk for invasive fungal infections after allogenic stem cell transplantation.
    Author: Christen D, Sohlbach K, Metzelder SK, Wollmer E, Hoeffkes HG, Naumann R, Burchardt A, Rummel M, Trenker C, Dohse M, Mack E, Klameth A, Mann C, Kostrewa P, Brendel C, Wündisch T, Neubauer A, Wilhelm C, Burchert A.
    Journal: Leuk Lymphoma; 2019 Aug; 60(8):2056-2061. PubMed ID: 30644334.
    Abstract:
    Patients who develop severe graft-versus-host disease (GvHD) after allogeneic stem cell transplantation (alloSCT) have a higher risk for invasive fungal infection (IFI). At our center, fluconazole prophylaxis is standard and upfront mold-effective prophylaxis performed only in patients with specific risk constellations. A total of 290 patients undergoing alloSCT between May 2002 and August 2011 were analyzed. Patients were regarded as high-risk if they suffered from acute GvHD II-IV° or extensive chronic GvHD. The 2-year incidence of an IFI after alloSCT was 8.97% (26/290) in the entire cohort and 7.78% (7/90) in the high-risk group. Mortality due to IFI was 3.85% (1/26) without including a high-risk patient. In the multivariate analysis a pre-transplant fungal infection was the only significant risk factor for developing an IFI after alloSCT (HR = 5.298; p = .001). A fluconazole prophylaxis in patients with GvHD after alloSCT is feasible in facilities with HEPA filtration and high awareness of clinical signs for IFI.
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