Invasive Fungal Disease in Patients Undergoing Umbilical Cord Blood Transplantation after Myeloablative Conditioning Regimen.

OBJECTIVE: Characteristics and risk factors (RFs) of invasive fungal disease (IFD) have been little studied in the setting of umbilical cord blood transplantation (UCBT).

METHOD: We retrospectively included 205 single-unit myeloablative UCBT recipients with a median follow-up of 64 months.

RESULTS: Fifty-six episodes of IFD were observed in 48 patients (23%) at a median time of 123 days after stem cell infusion. Invasive mold disease (IMD) occurred in 42 cases, 38 of them (90%) caused by invasive aspergillosis whereas invasive yeast disease (IYD) occurred in 14 cases, most of them due to candidemia (n= 12, 86%). The 5-year cumulative incidence of IFD, IMDs and IYDs was 24% 19% and 7%, respectively. In multivariate analysis, 3 RFs for IMDs were identified: age > 30 years (HR 3.5, p=0.017), acute grade II-IV graft-versus-host disease (HR 2.3, p=0.011) and ⩾1 previous transplant (HR 3.1, p=0.012). The probability of IMDs was 2.5%, 14% and 33% for recipients with none, 1, or 2 to 3 RFs, respectively (p< 0.001). Among IFD, IMDs had a negative effect on non-relapse mortality in multivariate analysis (HR 1.6, p=0.039). IMDs showed a negative impact on overall survival (HR 1.59, p=0.018).

CONCLUSION: IMDs were very common and serious complication after UCBT. This article is protected by copyright. All rights reserved.