Incidence and outcome of invasive fungal diseases in patients undergoing allogeneic hematopoietic stem cell transplant; retrospective analysis of a single center

Objectives: IFI is common in patients with allogeneic hematopoietic stem cell transplantation. Risk factors, such as GVHD, especially the aplasia period, also increase the risk of having IFI. Despite recent antifungal agents being used recently, IFI is an important cause of mortality in these patients. As the frequency of using antifungal prophylaxis increases, the importance of identifying the patient group, especially in terms of IFI, increases. According to the presence of risk factors in allogeneic transplant patients, the frequency of IFI is 8-26% and the mortality rate is between 25% and 90%. In this single center study, it was aimed to evaluate the frequency of fungal infections, risk factors, clinic, treatment and survival in allogeneic stem cell transplant patients. Materials and methods: This study was carried out in the hematology clinic of Ege University between January-2012 and December-2016 by screening 154 patient information systems and patient files which were allogeneic stem cell transplantation and met the criteria. Patients younger than 18 years and patients not receiving allogeneic transplants were not included in the study. Analysis was made on 154 patients. Results: Of the patients, 92 (59.7%) were male and 62 (40.3%) were female patients. The mean age of the patients was 41.87 ± 14.04 years (range 18 to 67 years). The most common indication for transplantation was AML (%37,7). The majority of patients were acute leukemia (%53,3). The presence of acute GVHD, the use of high-dose corticosteroids for GVHD, and the introduction of CMV infection were found to be significant risk factors for the development of IFI. The long duration of neutropenia and the short duration of xii prophylactic antifungal use were significantly associated with IFI development and mortality after allogeneic transplantation. Although the donor type was not significant in terms of IFI development, it was found to be significant in terms of mortality. It was significant that mortality was higher in unrelated transplants. Patients with proven IFI, probable IFI, possible IFI and the patients who initiated antifungal treatment for fever of unknown origin were included. The incidence was 48.7%. Looking at the proven IFI and probable IFI group, it was seen as 18.2%, similar to other studies. The mortality of IFI was 24%. Conclusion: In our study, we found similar risk factors with literature for IFI. At similar rates, the frequency and mortality of IFI were observed. As a result, we found the opportunity to investigate allogeneic transplant patients who developed IFI. It would be an appropriate option for each center to assess the IFI frequency of their patients and decide which treatment strategy is most beneficial for their patients.