Invasive mold infections after haematopoietic stem cell transplantation higher than expected

The incidence of proven or probable invasive mold infection in a real-life cohort of allogeneic haematopoietic stem cell transplantation recipients is higher than that seen in previous literature, according to a recent study.

“Invasive mold infections contribute to morbidity and mortality in patients undergoing allogeneic hematopoietic stem cell transplantation,” the investigators said. “The optimal strategy for primary antifungal prophylaxis in this patient population remains uncertain.”

Lead investigator Leah B Herity, from the Albany College of Pharmacy and Health Sciences, US, and her team retrospectively reviewed the medical records of patients who underwent allogeneic haematopoietic stem cell transplantation between 1 January 2013 and 31 December 2017.

Adult patients were eligible if they received micafungin followed by fluconazole, with the option to escalate to voriconazole, for antifungal prophylaxis.

Of the 200 patients included in the analysis, 79 percent underwent matched unrelated (46 percent) or matched related (33 percent) donor transplants.

The incidence rate of proven or probable invasive mold infection stood at 18.4 cases per 100 patient-years, with a 1-year cumulative incidence of 14 percent. Median time to proven or probable invasive mold infection was 94 days following transplantation, with invasive mold infection-related death occurring in 18 (64 percent) of 28 patients diagnosed with such infection.

Of note, no significant differences were noted in the comparison of invasive mold infection-free survival by potential risk factors.

“In the absence of standard guidance on antimold prophylaxis in this patient population and given that unique risk factors for invasive mold infection may differ between institutions, it is essential that centres performing allogeneic haematopoietic stem cell transplantation routinely monitor their antifungal prophylaxis strategies for effectiveness,” the investigators said.