Incidence and Outcome of Invasive Fungal Diseases after Allogeneic Stem Cell Transplantation: A Prospective Study of the Gruppo Italian Trapianto Midollo Osseo (GITMO)
Incidence and Outcome of Invasive Fungal Diseases after Allogeneic Stem Cell Transplantation: A Prospective Study of the Gruppo Italian Trapianto Midollo Osseo (GITMO)
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DOI：
10.1016/j.bbmt.2014.03.004
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发表时间：
2014-06-01
影响因子：
4.3
通讯作者：
Locasciulli, Anna
中科院分区：
文献类型：
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作者：
Girmenia, Corrado;Raiola, Anna Maria;Locasciulli, Anna
异基因造血干细胞移植（allo-HSCT）中侵袭性真菌病（IFD）的流行病学调查可能有助于确定可能受益于靶向治疗策略的亚群。 Gruppo Italiano Trapianto Midollo Osseo (GITMO) 前瞻性注册了 2008 年至 2010 年间 1858 名连续接受异基因造血干细胞移植 (allo-HSCT) 的患者的数据。进行逻辑回归分析，以确定早期（第 0 至 40 天）、晚期（第 41 至 100 天）和极晚（第 101 至 100 天）期间已证实/可能的 IFD (PP-IFD) 的危险因素。 3) allo-HSCT 后的阶段并评估 PP-IFD 对 1 年总生存率的影响。移植后 40 天、100 天和 12 个月时 PP-IFD 的累积发生率为 5.1%、6.7% 和 8.8%。多变量分析确定了以下与 PP-IFD 相关的变量：来自不相关的志愿者捐赠者或脐带血的移植、移植时的活动性急性白血病以及早期移植前的 IFD；来自无关志愿者捐献者或脐带血的移植以及晚期II-IV级急性移植物抗宿主病（GVHD）；以及II-IV级急性GVHD和非常晚期的广泛慢性GVHD。当急性 GVHD 随后发生慢性 GVHD 以及接受非匹配相关供体移植物移植的患者发生急性 GVHD 时，PP-IFD 的风险显着升高。 PP-IFD 的存在是长期生存的独立因素（风险比，2.90；95% 置信区间，2.32 至 3.62；P
Epidemiologic investigation of invasive fungal diseases (IFDs) in allogeneic hematopoietic stem cell transplantation (allo-HSCT) may be useful to identify subpopulations who might benefit from targeted treatment strategies. The Gruppo Italiano Trapianto Midollo Osseo (GITMO) prospectively registered data on 1858 consecutive patients undergoing allo-HSCT between 2008 and 2010. Logistic regression analysis was performed to identify risk factors for proven/probable IFD (PP-IFD) during the early (days 0 to 40), late (days 41 to 100), and very late (days 101 to 3) phases after allo-HSCT and to evaluate the impact of PP-IFDs on 1-year overall survival. The cumulative incidence of PP-IFDs was 5.1% at 40 days, 6.7% at 100 days, and 8.8% at 12 months post-transplantation. Multivariate analysis identified the following variables as associated with PP-IFDs: transplant from an unrelated volunteer donor or cord blood, active acute leukemia at the time of transplantation, and an IFD before transplantation in the early phase; transplant from an unrelated volunteer donor or cord blood and grade II-IV acute graft-versus-host disease (GVHD) in the late phase; and grade II-IV acute GVHD and extensive chronic GVHD in the very late phase. The risk for PP-IFD was significantly higher when acute GVHD was followed by chronic GVHD and when acute GVHD occurred in patients undergoing transplantation with grafts from other than matched related donors. The presence of PP-IFD was an independent factor in long-term survival (hazard ratio, 2.90; 95% confidence interval, 2.32 to 3.62; P