*Contributed equally to the work.
Risk factors and attributable mortality of late aspergillosis after T-cell depleted hematopoietic stem cell transplantation
Article first published online: 27 JUL 2007
Copyright © Blackwell Munksgaard 2007
Transplant Infectious Disease
Volume 10, Issue 3, pages 162–167, June 2008
How to Cite
Mihu, C.N., King, E., Yossepovitch, O., Taur, Y., Jakubowski, A., Pamer, E. and Papanicolaou, G.A. (2008), Risk factors and attributable mortality of late aspergillosis after T-cell depleted hematopoietic stem cell transplantation. Transplant Infectious Disease, 10: 162–167. doi: 10.1111/j.1399-3062.2007.00272.x
- Issue published online: 27 JUL 2007
- Article first published online: 27 JUL 2007
- Received 10 December 2006, revised 9 May 2007, accepted for publication 29 June 2007
- late aspergillosis;
- risk factors;
- T-cell depleted;
- allogeneic stem cell transplantation
Abstract: Aim. Invasive aspergillosis occurs in 5–15% of allogeneic hematopoietic stem cell transplant (HSCT) recipients. Through the 1990s there has been an increase in the incidence of late aspergillosis (LA). We report on the incidence, risk factors, and attributable mortality of LA in a cohort of 398 adult and pediatric patients at Memorial Sloan-Kettering Cancer Center from January 1999 through December 2003.
Methods. LA was defined as occurring >40 days post HSCT. LA cases were identified by prospective surveillance and examination of a computerized database. Probable or definite aspergillosis was defined by standard EORTC/MSG criteria. Mortality was attributed to LA if it caused or significantly contributed to death.
Results. The overall incidence of LA in our cohort was 4.1%. Median time from stem cell infusion to diagnosis of LA was 164 days (range 68–677) after HSCT. The incidence of LA among unmodified, T-cell depleted, or reduced intensity HSCT was 2.2%, 4%, and 6.8%, respectively (P not significant). Risk factors for LA were grade II–IV acute graft-versus-host disease (GVHD) (P=0.002), chronic GVHD (P=0.01), secondary neutropenia (P=0.02), and reduced intensity conditioning containing alemtuzumab (P=0.01). LA was the immediate cause of death in 1 of 10 (10%) T-cell depleted, 2 of 2 (100%) unmodified, and 1 of 4 (25%) of reduced-intensity HSCT.
Conclusions. LA developed a median 164 days post HSCT. All-cause 30-day mortality of LA was 56.3%. The majority of LA cases died of concurrent infections and not from invasive aspergillosis.