Invasive fungal infection (IFI) is becoming increasingly common in patients, undergoing bone marrow transplantation (BMT). We analyzed the incidence, causal pathogens, risk factors and outcome of IFI after BMT. The study population comprised 667 consecutive BMT patients (allogeneic 385. autologous 282) at Hadassah University Hospital from March 1993 to March 1998. Twenty nine patients (4.3%) developed definite IFI. Twenty five of them (86%) underwent allogeneic BMT (6,5%), 17 (68%) from fully matched sibling donors, 6 (24%) from haploidentical donors and 2 (8%) from unrelated donors, while 4 (14%) underwent autologous BMT ( 1.4%). Twentythree patients (79%) had hemato-oncological malignancies (CML-6, ALL-5, AML-4, MDS-1, MM-2, NHL-2, HD-2, neuroblastoma-1) while 6 (21%) had non- hernatological disease (SAA-5, Fanconi's anemia-I). Fifteen were male and 14 female with a median age of 26 (range 3-52 years). Causative organisms were Aspergillus species 16 (55%) (A. Flavus-13, A. nidulans-2, A. terrus-1), Candida species 11 (38%) (C. albicans-10, C. paraspilaris-1) and Mucor species 2 (7%). Median interval between BMT and IFI was 27 days (range 1-243 days). Eighteen of the IFIs (62%) were during the neutropenic (ANC<0.5 x 10/1) period post-BMT, Fifteen patients (60%) had either acute (>grade II) or chronic extensive graft versus host disease (GVHD). All patients received systemic amphotericin B (25 conventional and 4 amphotericin B colloidal dispersion [ABCD]). Seven patients underwent surgery (Caldwell-Luc facio-maxillary debridgement-3, spleneclomy-2, pulmonectomy-1 and neurosurgery-1). Five patients received granulocyte transfusions. Eight out of 29 patients (27%) responded to therapy but only five (17%) (Candida-3, Aspergillus-1, Mucor-1) are alive with a median follow-up of 12 months. In summary, IFI is a fatal complication in immunocompromised patients post-BMT. Heavy immunosuppression, previous chemo-radiotherapy, prolonged neutropenia and GVHD are risk factors. New effective treatment approaches are needed.
|Number of pages||1|
|State||Published - 1998|