Incidence, Risk Factors, and Long-term Outcome of Acute Leukemia Patients With Early Candidemia After Allogeneic Stem Cell Transplantation: A Study by the Acute Leukemia and Infectious Diseases Working Parties of European Society for Blood and Marrow Transplantation
Incidence, Risk Factors, and Long-term Outcome of Acute Leukemia Patients With Early Candidemia After Allogeneic Stem Cell Transplantation: A Study by the Acute Leukemia and Infectious Diseases Working Parties of European Society for Blood and Marrow Transplantation
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DOI：
10.1093/cid/ciy150
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发表时间：
2018-08-15
影响因子：
11.8
通讯作者：
Styczynski, Jan
中科院分区：
文献类型：
--
作者：
Cesaro, Simone;Tridello, Gloria;Styczynski, Jan
背景本研究旨在评估异基因造血干细胞移植（HSCT）后100天内念珠菌感染的发生率和危险因素，以及对长期生存的影响。我们对2000年至2012年接受HSCT的28542例急性白血病患者进行了结局分析。在第100天有347例患者出现念珠菌血症，28195例患者无念珠菌血症或任何其他类型的念珠菌感染。到第100天，念珠菌血症的发生率为1.2%，发生在HSCT后中位数22天。念珠菌血症患者的100天无复发死亡率（NRM;风险比[HR]，3.0，P < .0001）和100天总生存率（OS; HR，2.5，P < .0001）较高。念珠菌血症患者第100天的病死率为22%（76/347）。与念珠菌血症发生相关的因素包括女性、骨髓或脐带血干细胞来源、T细胞耗竭、全身照射和急性移植物抗宿主病。在第100天存活的患者中，中位随访5.6年（95%置信区间，5.5 - 5.7）后，伴和不伴念珠菌血症的患者的5年NRM和OS分别为22.5%和13.5%，P <0.0001和45.6%和53.4%，P = 0.0003。在多变量分析中，第100天发生念珠菌血症是NRM较高（HR，1.7，P = .001）和OS较低（HR，1.4，P = .001）的独立危险因素。HSCT后早期发生念珠菌血症仍与较高的NRM和较低的短期和长期OS相关。
Background. This study was performed to assess the incidence of and risk factors for Candida infection in the first 100 days after allogeneic hematopoietic stem cell transplantation (HSCT) and the impact on long-term survival.Methods. We performed an outcome analysis of 28 542 acute leukemia patients who underwent HSCT from 2000 to 2012. There were 347 patients with candidemia by day 100 and 28 195 without candidemia or any other type of Candida infection.Results. The incidence of candidemia by day 100 was 1.2% and occurred at a median of 22 days after HSCT. Higher 100-day nonrelapse mortality (NRM; hazards ratio [HR], 3.0, P < .0001) and lower 100-day overall survival (OS; HR, 2.5, P < .0001) were observed in patients with candidemia. The case fatality rate by day 100 in patients with candidemia was 22% (76/347). Factors associated with candidemia occurrence were female gender, bone marrow or cord blood stem cell source, T-cell depletion, use of total body irradiation, and acute graft vs host disease. Among the patients alive at day 100, the 5-year NRM and OS after a median follow-up of 5.6 years (95% confidence interval, 5.5 - 5.7) for patients with and without candidemia were 22.5% vs 13.5%, P < .0001 and 45.6% vs. 53.4%, P =.0003, respectively. In multivariate analysis, the occurrence of a candidemia episode by day 100 was an independent risk factor for higher NRM (HR, 1.7, P = .001) and lower OS (HR, 1.4, P = .001).Conclusions. The early occurrence of candidemia after HSCT is still associated with higher NRM and lower short-and-long-term OS.