Epidemiology of invasive mold infections in allogeneic stem cell transplant recipients: biological risk factors for infection according to time after transplantation.
Epidemiology of invasive mold infections in allogeneic stem cell transplant recipients: biological risk factors for infection according to time after transplantation.
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DOI：
10.1086/591969
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发表时间：
2008-10-15
期刊：
影响因子：
--
通讯作者：
Marr KA
中科院分区：
文献类型：
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作者：
Garcia-Vidal C;Upton A;Kirby KA;Marr KA
侵袭性霉菌感染 (IMIs) 在接受造血干细胞移植 (HSCT) 的个体中很常见。我们试图确定同种异体 HSCT 后每个时期（早期和晚期）不同 IMI 的临床和生物学风险因素。包括 1998 年 1 月 1 日至 2002 年 12 月 31 日期间在 Fred Hutchinson 癌症研究中心（华盛顿州西雅图）的 HSCT 受者中诊断出的已证实和可能的 IMI 病例。使用 Kaplan-Meier 曲线估计生存率，并使用 Cox 回归模型进行多变量分析。研究期间，1248名患者接受了同种异体HSCT； 163 人 (13.1%) 被诊断为可能或已证实的 IMI。大多数病例是由曲霉属物种引起的（88%）。在 4 年的研究期间，由其他霉菌引起的 IMI 发生率仍然很低（<2%）。 HSCT早期和HSCT后晚期IMI的危险因素不同，宿主变量（年龄）和移植变量（人类白细胞抗原匹配）作为早期危险因素占主导地位，而其他临床并发症（移植物抗宿主病和巨细胞病毒病）则在后期占主导地位。在所有时期都很重要的生物危险因素包括多种血细胞减少症（中性粒细胞减少症、淋巴细胞减少症和单核细胞减少症）和铁超载。同种异体 HSCT 后发生侵袭性曲霉病的危险因素是多因素的，并且根据 HSCT 后的时间而有所不同。应更加重视了解 HSCT 后真菌病的免疫发病机制。
Invasive mold infections (IMIs) are common in individuals who have undergone hematopoietic stem cell transplantation (HSCT). We sought to determine clinical and biological risk factors for different IMIs during each period (early and late) after allogeneic HSCT. Cases of proven and probable IMI diagnosed in HSCT recipients at the Fred Hutchinson Cancer Research Center (Seattle, WA) from 1 January 1998 through 31 December 2002 were included. Survival was estimated with Kaplan-Meier curves, and Cox regression models were used for multivariable analyses. During the study period, 1248 patients underwent allogeneic HSCT; 163 (13.1%) received a diagnosis of probable or proven IMI. The majority of cases were caused by Aspergillus species (88%). The incidence of IMI caused by other molds remained low (<2%) over the 4-year study period. Risk factors for IMI early after HSCT and late after HSCT differed, with host variables (age) and transplant variables (human leukocyte antigen match) predominating as early risk factors and other clinical complications (graft-versus-host disease and cytomegalovirus disease) predominating later. Biological risk factors that were important during all periods included multiple cytopenias (neutropenia, lymphopenia, and monocytopenia) and iron overload. Risk factors for invasive aspergillosis after allogeneic HSCT are multifactorial and differ according to timing after HSCT. Increased attention should be placed on understanding the immunopathogenesis of fungal disease after HSCT.