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Early Occurrence of Candidemia After HSCT in Patients With Acute Leukemia
A recent study investigated the incidence and risk factors of candidemia immediately after allogeneic hematopoietic stem cell transplantation (HSCT).
The study will be published in Clinical Infectious Diseases (online February 22, 2018; doi:10.1093/cid/ciy150).
Simone Cesaro, MD, Hospital Trust of Verona (Italy), and colleagues analyzed 28,542 patients with acute leukemia who underwent HSCT from 2000 to 2012. Among the total patient population, 1.2% (n = 347) had candidemia within 100 days and the remaining 28,195 did not have candidemia or any other type of Candida infection.
Within 100 days from HSCT, the incidence of candidemia infection occurred at a median of 22 days after HSCT. A higher 100-day non-relapse mortality (HR, 3.0; P < .0001) and a lower 100-day overall survival (HR, 2.5; P < .0001) were observed in patients with candidemia infection. The case fatality rate by day 100 in patients with candidemia infection was 22% (n = 76).
The study found several factors—gender female, bone marrow or cord blood stem cell source, T-cell depletion, use of total body irradiation, and acute graft versus host disease—to be associated with higher incidence of candidemia infection.
Among the patients alive at day 100, the 5-year non-relapse mortality and overall survival after a median follow-up of 5.6 years for patients with and without candidemia were 22.5% vs 13.5% (P < .0001) and 45.6% vs 53.4% (P = .0003), respectively.
Multivariate analysis showed the occurrence of a candidemia episode by day 100 was an independent risk factor for higher non-relapse mortality (HR, 1.7; P = .001) and lower overall survival (HR, 1.4; P = .001).
The authors of the study concluded that despite the general improvements in prophylaxis and treatment, the early occurrence of candidemia after HSCT is associated with higher non-relapse mortality and lower overall survival.—Janelle Bradley
