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Epidemiology and Risk Factors for Invasive Fungal Diseases among Allogeneic Hematopoietic Stem Cell Transplant Recipients in Korea: Results of "RISK" Study

Authors
 Jae-Ki Choi  ;  Sung-Yeon Cho  ;  Sung-Soo Yoon  ;  Joon-Ho Moon  ;  Sung-Han Kim  ;  Je-Hwan Lee  ;  Jin Seok Kim  ;  June-Won Cheong  ;  Jun-Ho Jang  ;  Bo-Jeong Seo  ;  Young-Joo Kim  ;  Hye-Jung Lee  ;  Juneyoung Lee  ;  Jong Wook Lee  ;  Dong-Gun Lee 
Citation
 Biology of Blood and Marrow Transplantation, Vol.23(10) : 1773-1779, 2017 
Journal Title
 Biology of Blood and Marrow Transplantation 
ISSN
 1083-8791 
Issue Date
2017
Keywords
Epidemiology ; Hematopoietic stem cell transplantation ; Mycoses ; Republic of Korea ; Risk factors
Abstract
Incidence, epidemiology, and risk factors of invasive fungal diseases (IFDs) in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients can vary from different cohorts and countries. Therefore, we performed a nationwide study to establish a proper antifungal prophylaxis strategies based on risk stratifications of IFDs after all-HSCT in Korea (RISK study). This was a multicenter, retrospective, and observational study in Korea. All consecutive adult patients who received allo-HSCT in 2013 were included. The 12-month cumulative incidence of proven/probable IFDs (PP-IFDs) was calculated during the early (days 0 to 40), late (days 41 to 100), and very late (days 101 to 365) phases after allo-HSCT. Cox proportional hazard regression analysis was performed to identify risk factors for PP-IFDs at each phase. A total 521 allo-HSCT cases in 518 patients were analyzed. Overall cumulative incidence of PP-IFDs were 4.09% (95% confidence interval [CI], 2.38 to 5.81), 7.38% (95% CI, 5.09 to 9.67), and 15.36% (95% CI, 12.04 to 18.68) at the early, late and very phases, respectively. In multiple Cox regression analysis, variables were associated with PP-IFDs in each period were identified. Variables associated with early phase include underlying pulmonary diseases, underlying nonmalignant stable or chronic disease at allo-HSCT, unrelated or family mismatched donor, and prolonged neutropenia. Variables associated with the late phase include high ferritin level at the time point of allo-HSCT, use of secondary immunosuppressive agents due to refractory graft-versus-host disease (GVHD), and cytomegalovirus reactivation. For the very late phase, variables were secondary neutropenia, severe chronic GVHD, and use of TNF-alpha inhibitor for refractory GVHD. This study revealed the high cumulative incidence of IFDs in Korean allo-HSCT recipients, which have distinct risk factors in each phase after allo-HSCT. Our findings indicate that tailored antifungal prophylaxis is necessary for high-risk patients. Clinicians should consider using mold-active antifungal prophylaxis in allo-HSCT recipients who have high risks at different treatment period.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/161139
DOI
10.1016/j.bbmt.2017.06.012
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
Yonsei Authors
김진석(Kim, Jin Seok) ; 정준원(Cheong, June-Won)
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Full Text
https://www.sciencedirect.com/science/article/pii/S1083879117305219
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