Characteristics And Risk Factors Of Invasive Fungal Disease In Hematopoietic Stem Cell Transplantation

Objectives By studying the clinical characteristics of invasive fungal disease(IFD)after hematopoietic stem cell transplantation(HSCT)in patients with hematological diseases in our hospital,and analyzing the risk factors of IFD after HSCT,the basis for clinical antifungal prophylaxis and treatment is provided.Methods A retrospective study was conducted on 233 patients with hematological diseases treated by HSCT in the Department of Hematology,the First Affiliated Hospital of Chongqing Medical University from January2016 to December 2018.Age,gender,underlying diseases,complications,neutropenia time,use of glucocorticoids and other data were collected and analyzed by using SPSS 25.0 statistical software to understand the clinical characteristics and risk factors of IFD among these patients.Results Among the 233 patients,41 were diagnosed as IFD,of which 7 cases were proven(3.0%),34 cases were probable(14.6%),and the total incidence was 17.6%.Meanwhile,out of the 41 proven/probable IFD,32 cases(78.0%)were breakthrough invasive fungal disease,with the total incidence of 13.7%.Among the auto-HSCT recipients,previous history of IFD and neutropenia > 14 days were risk factors of IFD.Among the allo-HSCT recipients,univariate analysis revealed that the previous history of IFD,EB virus infection,CMV infection,underlying lung disease,cGVHD,neutropenia > 14 days,and the use of high-dose glucocorticoids as risk factors for IFD.Multivariate analysis suggested that the previous history of IFD,chronic graft-versus-host disease,neutropenia > 14 days,and the use of high-dose glucocorticoid were independent risk factors of IFD.The risk factor of bIFD in proven/probable IFD is neutropenia > 14 days.Conclusion The incidence and mortality of invasive fungal diseases after HSCT are high,and the percentage of breakthrough IFD during primary antifungal prophylaxis is also high.The risk factors of patients should be evaluated in the clinic;prevention and treatment should be given in time;monitoring of the patients with neutropenia should be strengthened;glucocorticoids should be used reasonably,and the occurrence of IFD should be alerted.