Biology of Blood and Marrow Transplantation
Volume 13, Issue 7 , Pages 771-777, July 2007

Invasive Fungal Infection Following Reduced-Intensity Cord Blood Transplantation for Adult Patients with Hematologic Diseases

  • Shigesaburo Miyakoshi

      Affiliations

    • Department of Hematology, Toranomon Hospital, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
    • ,
  • Eiji Kusumi

      Affiliations

    • Department of Hematology, Toranomon Hospital, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
    • Division of Exploratory Research, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
    • ,
  • Tomoko Matsumura

      Affiliations

    • Department of Hematology, Toranomon Hospital, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
    • Division of Exploratory Research, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
    • ,
  • Akiko Hori

      Affiliations

    • Division of Exploratory Research, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
    • ,
  • Naoko Murashige

      Affiliations

    • Hematopoietic Stem Cell Transplantation Unit, National Cancer Center Hospital, Tokyo, Japan
    • ,
  • Tamae Hamaki

      Affiliations

    • Division of Exploratory Research, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
    • ,
  • Koichiro Yuji

      Affiliations

    • Department of Hematology, Toranomon Hospital, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
    • Division of Exploratory Research, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
    • ,
  • Naoyuki Uchida

      Affiliations

    • Department of Hematology, Toranomon Hospital, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
    • ,
  • Kazuhiro Masuoka

      Affiliations

    • Department of Hematology, Toranomon Hospital, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
    • ,
  • Atsushi Wake

      Affiliations

    • Department of Hematology, Toranomon Hospital, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
    • ,
  • Yoshinobu Kanda

      Affiliations

    • Department of Cell Therapy and Transplantation Medicine, University of Tokyo Hospital, Tokyo, Japan
    • ,
  • Masahiro Kami

      Affiliations

    • Division of Exploratory Research, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
    • ,
  • Yuji Tanaka

      Affiliations

    • Division of Exploratory Research, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
    • Corresponding Author InformationCorrespondence and reprint requests: Yuji Tanaka, M.D., Division of Exploratory Research, the Institute of Medical Science, the University of Tokyo, Tokyo 1088639 Japan.
    • ,
  • Shuichi Taniguchi

      Affiliations

    • Department of Hematology, Toranomon Hospital, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan

Received 13 November 2006; accepted 23 February 2007.

Abstract 

Invasive fungal infection (IFI) is a significant complication after allogeneic hematopoietic stem cell transplantation (HSCT); however, we have little information on its clinical features after reduced intensity cord blood transplantation (RICBT) for adults. We reviewed medical records of 128 patients who underwent RICBT at Toranomon Hospital between March 2002 and November 2005. Most of the patients received purine-analogbased preparative regimens. Graft-versus-host disease (GVHD) prophylaxis was a continuous infusion of either tacrolimus 0.03 mg/kg or cyclosporine 3 mg/kg. IFI was diagnosed according to the established EORTC/NIH-MSG criteria. IFI was diagnosed in 14 patients. Thirteen of the 14 had probable invasive pulmonary aspergillosis and the other had fungemia resulting from Trichosporon spp. Median onset of IFI was day 20 (range: 1-82), and no patients developed IFI after day 100. Three-year cumulative incidence of IA was 10.2%. Four of the 13 patients with invasive aspergillosis (IA) developed grade II-IV acute GVHD, and their IA was diagnosed before the onset of acute GVHD. The mortality rate of IFI was 86%. Multivariate analysis revealed that the use of prednisolone >0.2 mg/kg (relative risk 7.97, 95% confidence interval 2.24-28.4, P = .0014) was a significant risk factor for IA. This study suggests that IFI is an important cause of deaths after RICBT, and effective strategies are warranted to prevent IFI.

Key Words: Invasive aspergillosis, Graft-versus-host disease, Corticosteroid

 

PII: S1083-8791(07)00188-7

doi:10.1016/j.bbmt.2007.02.012

Biology of Blood and Marrow Transplantation
Volume 13, Issue 7 , Pages 771-777, July 2007

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