Outcome of non-mold effective anti-fungal prophylaxis in patients at high-risk for invasive fungal infections after allogenic stem cell transplantation

Abstract

Patients who develop severe graft-versus-host disease (GvHD) after allogeneic stem cell transplantation (alloSCT) have a higher risk for invasive fungal infection (IFI). At our center, fluconazole prophylaxis is standard and upfront mold-effective prophylaxis performed only in patients with specific risk constellations. A total of 290 patients undergoing alloSCT between May 2002 and August 2011 were analyzed. Patients were regarded as high-risk if they suffered from acute GvHD II–IV° or extensive chronic GvHD. The 2-year incidence of an IFI after alloSCT was 8.97% (26/290) in the entire cohort and 7.78% (7/90) in the high-risk group. Mortality due to IFI was 3.85% (1/26) without including a high-risk patient. In the multivariate analysis a pre-transplant fungal infection was the only significant risk factor for developing an IFI after alloSCT (HR = 5.298; p = .001). A fluconazole prophylaxis in patients with GvHD after alloSCT is feasible in facilities with HEPA filtration and high awareness of clinical signs for IFI.

Keywords:

• Allogeneic stem cell transplantation
• invasive fungal infection
• anti-fungal prophylaxis
• GvHD

Acknowledgments

We thank Prof. Klose for important discussions during the project design phase.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at http://10.1080/10428194.2018.1553303.

Additional information

Funding

This work was supported by grants from Deutsche Forschungsgemeinschaft, Deutsche Krebshilfe, and José Carreras Leukämie-Stiftung.