https://orcid.org/0000-0003-4217-5039
Abstract
This study (China Assessment of Antifungal Therapy in Hematological Diseases [CAESAR 2.0]) aimed to provide updated epidemiological data on invasive fungal disease (IFD) in patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT).
This multicenter, real-world, observational study was conducted at 12 allo-HSCT centers in China between January and December 2021. Consecutive adult patients (aged ≥18 years) who underwent allo-HSCT with antifungal prophylaxis were included. IFD was diagnosed according to the 2019 criteria of the European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC/MSG). Follow-up was completed by 31 December 2022.
A total of 2015 patients were included. Mold-active antifungal prophylaxis was used in 76.08%, most of whom received voriconazole (44.37%) or posaconazole (31.71%). The cumulative incidence of IFD (proven or probable) 1 year after allo-HSCT was 6.3%. Pathogens were identified in 47.97% of IFD cases and mainly included Candida spp. (17.89%), Mucorales (13.01%), Aspergillus spp. (8.94%), and Pneumocystis jirovecii (6.5%). Multivariate analysis identified the following factors associated with IFD: disease at advanced stage (hazard ratio, 2.55 [95% confidence interval, 1.58–4.12]; P < .001), absolute neutrophil count engraftment (≤28 days) (0.37 [15–.92]; P = .03), platelet engraftment (≤28 days) (0.41 [.27–.62]; P < .001), and acute graft-vs-host disease grade III–IV (2.97 [1.97–4.49]; P < .001). The IFD-attributable mortality rate was 48.28%.
Despite the widespread use of mold-active prophylaxis, the risk of IFD after allo-HSCT remains high. The most common pathogens are Candida spp., Mucorales, Aspergillus spp., and P. jirovecii.
This graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/invasive-fungal-disease-in-patients-undergoing-allogeneic-hematopoietic-stem-cell-transplantation-in-china-a-multicenter-epidemiological-study-caesar-2-0-e0c69e2e-f6cc-400f-b180-72beac0624bf?utm_campaign=tidbitlinkshare&utm_source=IO
