Invasive aspergillosis in allogeneic stem cell transplant recipients: changes in epidemiology and risk factors
Invasive aspergillosis in allogeneic stem cell transplant recipients: changes in epidemiology and risk factors
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DOI：
10.1182/blood-2002-05-1496
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发表时间：
2002-12-15
期刊：
影响因子：
20.3
通讯作者：
Corey, L
中科院分区：
文献类型：
--
作者：
Marr, KA;Carter, RA;Corey, L
20 世纪 90 年代，造血干细胞移植 (HSCT) 受者移植后侵袭性曲霉病 (IA) 的发病率有所增加。我们确定了 1993 年 1 月至 1998 年 12 月期间接受 HSCT 的 1682 名患者的 IA 风险和结果。风险因素包括宿主变量（年龄、基础疾病）、移植变量（干细胞来源）和晚期并发症（急性和慢性移植物抗宿主病 [GVHD]、接受皮质类固醇、继发性中性粒细胞减少症、巨细胞病毒 [CMV] 疾病和 呼吸道病毒感染）。我们在移植后（小于或等于 40 天）和植入后（41-180 天）早期确定了与 IA 相关的危险因素。在这两个时期，较大的患者年龄都与风险增加相关。与其他血液系统恶性肿瘤、再生障碍性贫血和骨髓增生异常综合征相比，慢性粒细胞白血病 (CML) 慢性期与早期 IA 的风险较低相关。多发性骨髓瘤与移植后风险增加相关[A.与使用 MR 骨髓相比，使用人类白细胞抗原 (HLA) 匹配相关 (MR) 外周血干细胞可针对早期 IA 提供保护，但使用脐带血会增加移植后早期 IA 的风险。植入后增加 IA 风险的因素包括接受 T 细胞耗尽或 CD34 选择的干细胞产品、接受皮质类固醇、中性粒细胞减少症、淋巴细胞减少症、GVHD、CMV 疾病和呼吸道病毒感染。非常晚的 IA（移植后 > 6 个月）与慢性 GVHD 和 CMV 疾病相关。这些结果强调了 IA 的移植后时间；危险因素分析验证了先前认识的危险因素（GVHD、接受皮质类固醇和中性粒细胞减少症），并揭示了淋巴细胞减少症和病毒感染在 20 世纪 90 年代增加移植后 IA 发病率中的作用。
The incidence of postengraftment invasive aspergillosis (IA) in hematopoietic stem cell transplant (HSCT) recipients increased during the 1990s. We determined risks for IA and outcomes among 1682 patients who received HSCTs between January 1993 and December 1998. Risk factors included host variables (age, underlying disease), transplant variables (stem cell source), and late complications (acute and chronic graft-versus-host disease [GVHD], receipt of corticosteroids, secondary neutropenia, cytomegalovirus [CMV] disease, and respiratory virus infection). We identified risk factors associated with IA early after transplantation less than or equal to40 days) and after engraftment (41-180 days). Older patient age was associated with an increased risk during both periods. Chronic myelogenous leukemia (CML) in chronic phase was associated with low risk for early IA compared with other hematologic malignancies, aplastic anemia, and myelodysplastic syndrome. Multiple myeloma was associated with an increased risk for postengraftment [A. Use of human leukocyte antigen (HLA)-matched related (MR) peripheral blood stem cells conferred protection against early IA compared with use of MR bone marrow, but use of cord blood increased the risk of IA early after transplantation. Factors that increased risks for IA after engraftment included receipt of T cell-depleted or CD34-selected stem cell products, receipt of corticosteroids, neutropenia, lymphopenia, GVHD, CMV disease, and respiratory virus infections. Very late IA (> 6 months after transplantation) was associated with chronic GVHD and CMV disease. These results emphasize the postengraftment timing of IA; risk factor analyses verify previously recognized risk factors (GVHD, receipt of corticosteroids, and neutropenia) and uncover the roles of lymphopenia and viral infections in increasing the incidence of postengraftment IA in the 1990s.