Pre-existing invasive fungal infection is not a contraindication for allogeneic HSCT for patients with hematologic malignancies: A CIBMTR study

Richard Maziarz, R. Brazauskas, M. Chen, A. A. McLeod, R. Martino, J. R. Wingard, M. Aljurf, M. Battiwalla, C. C. Dvorak, B. Geroge, E. C. Guinan, G. A. Hale, H. M. Lazarus, J. W. Lee, J. L. Liesveld, M. Ramanathan, V. Reddy, B. N. Savani, F. O. Smith, Lynne StrasfeldR. A. Taplitz, C. Ustun, M. J. Boeckh, J. Gea-Banacloche, C. A. Lindemans, J. J. Auletta, M. L. Riches

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Patients with prior invasive fungal infection (IFI) increasingly proceed to allogeneic hematopoietic cell transplantation (HSCT). However, little is known about the impact of prior IFI on survival. Patients with pre-transplant IFI (cases; n=825) were compared with controls (n=10247). A subset analysis assessed outcomes in leukemia patients pre- and post 2001. Cases were older with lower performance status (KPS), more advanced disease, higher likelihood of AML and having received cord blood, reduced intensity conditioning, mold-active fungal prophylaxis and more recently transplanted. Aspergillus spp. and Candida spp. were the most commonly identified pathogens. 68% of patients had primarily pulmonary involvement. Univariate and multivariable analysis demonstrated inferior PFS and overall survival (OS) for cases. At 2 years, cases had higher mortality and shorter PFS with significant increases in non-relapse mortality (NRM) but no difference in relapse. One year probability of post-HSCT IFI was 24% (cases) and 17% (control, P<0.001). The predominant cause of death was underlying malignancy; infectious death was higher in cases (13% vs 9%). In the subset analysis, patients transplanted before 2001 had increased NRM with inferior OS and PFS compared with later cases. Pre-transplant IFI is associated with lower PFS and OS after allogeneic HSCT but significant survivorship was observed. Consequently, pre-transplant IFI should not be a contraindication to allogeneic HSCT in otherwise suitable candidates. Documented pre-transplant IFI is associated with lower PFS and OS after allogeneic HSCT. However, mortality post transplant is more influenced by advanced disease status than previous IFI. Pre-transplant IFI does not appear to be a contraindication to allogeneic HSCT.

Original languageEnglish (US)
Pages (from-to)270-278
Number of pages9
JournalBone Marrow Transplantation
Volume52
Issue number2
DOIs
StatePublished - Feb 1 2017

Fingerprint

Hematologic Neoplasms
Transplants
Survival
Mortality
Invasive Fungal Infections
Cell Transplantation
Aspergillus
Fetal Blood
Candida
Cause of Death
Leukemia
Fungi
Survival Rate
Recurrence
Lung

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Pre-existing invasive fungal infection is not a contraindication for allogeneic HSCT for patients with hematologic malignancies : A CIBMTR study. / Maziarz, Richard; Brazauskas, R.; Chen, M.; McLeod, A. A.; Martino, R.; Wingard, J. R.; Aljurf, M.; Battiwalla, M.; Dvorak, C. C.; Geroge, B.; Guinan, E. C.; Hale, G. A.; Lazarus, H. M.; Lee, J. W.; Liesveld, J. L.; Ramanathan, M.; Reddy, V.; Savani, B. N.; Smith, F. O.; Strasfeld, Lynne; Taplitz, R. A.; Ustun, C.; Boeckh, M. J.; Gea-Banacloche, J.; Lindemans, C. A.; Auletta, J. J.; Riches, M. L.

In: Bone Marrow Transplantation, Vol. 52, No. 2, 01.02.2017, p. 270-278.

Research output: Contribution to journalArticle

Maziarz, R, Brazauskas, R, Chen, M, McLeod, AA, Martino, R, Wingard, JR, Aljurf, M, Battiwalla, M, Dvorak, CC, Geroge, B, Guinan, EC, Hale, GA, Lazarus, HM, Lee, JW, Liesveld, JL, Ramanathan, M, Reddy, V, Savani, BN, Smith, FO, Strasfeld, L, Taplitz, RA, Ustun, C, Boeckh, MJ, Gea-Banacloche, J, Lindemans, CA, Auletta, JJ & Riches, ML 2017, 'Pre-existing invasive fungal infection is not a contraindication for allogeneic HSCT for patients with hematologic malignancies: A CIBMTR study', Bone Marrow Transplantation, vol. 52, no. 2, pp. 270-278. https://doi.org/10.1038/bmt.2016.259
Maziarz, Richard ; Brazauskas, R. ; Chen, M. ; McLeod, A. A. ; Martino, R. ; Wingard, J. R. ; Aljurf, M. ; Battiwalla, M. ; Dvorak, C. C. ; Geroge, B. ; Guinan, E. C. ; Hale, G. A. ; Lazarus, H. M. ; Lee, J. W. ; Liesveld, J. L. ; Ramanathan, M. ; Reddy, V. ; Savani, B. N. ; Smith, F. O. ; Strasfeld, Lynne ; Taplitz, R. A. ; Ustun, C. ; Boeckh, M. J. ; Gea-Banacloche, J. ; Lindemans, C. A. ; Auletta, J. J. ; Riches, M. L. / Pre-existing invasive fungal infection is not a contraindication for allogeneic HSCT for patients with hematologic malignancies : A CIBMTR study. In: Bone Marrow Transplantation. 2017 ; Vol. 52, No. 2. pp. 270-278.
@article{6f487b9d8342446c9ae68b78169e9d03,
title = "Pre-existing invasive fungal infection is not a contraindication for allogeneic HSCT for patients with hematologic malignancies: A CIBMTR study",
abstract = "Patients with prior invasive fungal infection (IFI) increasingly proceed to allogeneic hematopoietic cell transplantation (HSCT). However, little is known about the impact of prior IFI on survival. Patients with pre-transplant IFI (cases; n=825) were compared with controls (n=10247). A subset analysis assessed outcomes in leukemia patients pre- and post 2001. Cases were older with lower performance status (KPS), more advanced disease, higher likelihood of AML and having received cord blood, reduced intensity conditioning, mold-active fungal prophylaxis and more recently transplanted. Aspergillus spp. and Candida spp. were the most commonly identified pathogens. 68{\%} of patients had primarily pulmonary involvement. Univariate and multivariable analysis demonstrated inferior PFS and overall survival (OS) for cases. At 2 years, cases had higher mortality and shorter PFS with significant increases in non-relapse mortality (NRM) but no difference in relapse. One year probability of post-HSCT IFI was 24{\%} (cases) and 17{\%} (control, P<0.001). The predominant cause of death was underlying malignancy; infectious death was higher in cases (13{\%} vs 9{\%}). In the subset analysis, patients transplanted before 2001 had increased NRM with inferior OS and PFS compared with later cases. Pre-transplant IFI is associated with lower PFS and OS after allogeneic HSCT but significant survivorship was observed. Consequently, pre-transplant IFI should not be a contraindication to allogeneic HSCT in otherwise suitable candidates. Documented pre-transplant IFI is associated with lower PFS and OS after allogeneic HSCT. However, mortality post transplant is more influenced by advanced disease status than previous IFI. Pre-transplant IFI does not appear to be a contraindication to allogeneic HSCT.",
author = "Richard Maziarz and R. Brazauskas and M. Chen and McLeod, {A. A.} and R. Martino and Wingard, {J. R.} and M. Aljurf and M. Battiwalla and Dvorak, {C. C.} and B. Geroge and Guinan, {E. C.} and Hale, {G. A.} and Lazarus, {H. M.} and Lee, {J. W.} and Liesveld, {J. L.} and M. Ramanathan and V. Reddy and Savani, {B. N.} and Smith, {F. O.} and Lynne Strasfeld and Taplitz, {R. A.} and C. Ustun and Boeckh, {M. J.} and J. Gea-Banacloche and Lindemans, {C. A.} and Auletta, {J. J.} and Riches, {M. L.}",
year = "2017",
month = "2",
day = "1",
doi = "10.1038/bmt.2016.259",
language = "English (US)",
volume = "52",
pages = "270--278",
journal = "Bone Marrow Transplantation",
issn = "0268-3369",
publisher = "Nature Publishing Group",
number = "2",

}

TY - JOUR

T1 - Pre-existing invasive fungal infection is not a contraindication for allogeneic HSCT for patients with hematologic malignancies

T2 - A CIBMTR study

AU - Maziarz, Richard

AU - Brazauskas, R.

AU - Chen, M.

AU - McLeod, A. A.

AU - Martino, R.

AU - Wingard, J. R.

AU - Aljurf, M.

AU - Battiwalla, M.

AU - Dvorak, C. C.

AU - Geroge, B.

AU - Guinan, E. C.

AU - Hale, G. A.

AU - Lazarus, H. M.

AU - Lee, J. W.

AU - Liesveld, J. L.

AU - Ramanathan, M.

AU - Reddy, V.

AU - Savani, B. N.

AU - Smith, F. O.

AU - Strasfeld, Lynne

AU - Taplitz, R. A.

AU - Ustun, C.

AU - Boeckh, M. J.

AU - Gea-Banacloche, J.

AU - Lindemans, C. A.

AU - Auletta, J. J.

AU - Riches, M. L.

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Patients with prior invasive fungal infection (IFI) increasingly proceed to allogeneic hematopoietic cell transplantation (HSCT). However, little is known about the impact of prior IFI on survival. Patients with pre-transplant IFI (cases; n=825) were compared with controls (n=10247). A subset analysis assessed outcomes in leukemia patients pre- and post 2001. Cases were older with lower performance status (KPS), more advanced disease, higher likelihood of AML and having received cord blood, reduced intensity conditioning, mold-active fungal prophylaxis and more recently transplanted. Aspergillus spp. and Candida spp. were the most commonly identified pathogens. 68% of patients had primarily pulmonary involvement. Univariate and multivariable analysis demonstrated inferior PFS and overall survival (OS) for cases. At 2 years, cases had higher mortality and shorter PFS with significant increases in non-relapse mortality (NRM) but no difference in relapse. One year probability of post-HSCT IFI was 24% (cases) and 17% (control, P<0.001). The predominant cause of death was underlying malignancy; infectious death was higher in cases (13% vs 9%). In the subset analysis, patients transplanted before 2001 had increased NRM with inferior OS and PFS compared with later cases. Pre-transplant IFI is associated with lower PFS and OS after allogeneic HSCT but significant survivorship was observed. Consequently, pre-transplant IFI should not be a contraindication to allogeneic HSCT in otherwise suitable candidates. Documented pre-transplant IFI is associated with lower PFS and OS after allogeneic HSCT. However, mortality post transplant is more influenced by advanced disease status than previous IFI. Pre-transplant IFI does not appear to be a contraindication to allogeneic HSCT.

AB - Patients with prior invasive fungal infection (IFI) increasingly proceed to allogeneic hematopoietic cell transplantation (HSCT). However, little is known about the impact of prior IFI on survival. Patients with pre-transplant IFI (cases; n=825) were compared with controls (n=10247). A subset analysis assessed outcomes in leukemia patients pre- and post 2001. Cases were older with lower performance status (KPS), more advanced disease, higher likelihood of AML and having received cord blood, reduced intensity conditioning, mold-active fungal prophylaxis and more recently transplanted. Aspergillus spp. and Candida spp. were the most commonly identified pathogens. 68% of patients had primarily pulmonary involvement. Univariate and multivariable analysis demonstrated inferior PFS and overall survival (OS) for cases. At 2 years, cases had higher mortality and shorter PFS with significant increases in non-relapse mortality (NRM) but no difference in relapse. One year probability of post-HSCT IFI was 24% (cases) and 17% (control, P<0.001). The predominant cause of death was underlying malignancy; infectious death was higher in cases (13% vs 9%). In the subset analysis, patients transplanted before 2001 had increased NRM with inferior OS and PFS compared with later cases. Pre-transplant IFI is associated with lower PFS and OS after allogeneic HSCT but significant survivorship was observed. Consequently, pre-transplant IFI should not be a contraindication to allogeneic HSCT in otherwise suitable candidates. Documented pre-transplant IFI is associated with lower PFS and OS after allogeneic HSCT. However, mortality post transplant is more influenced by advanced disease status than previous IFI. Pre-transplant IFI does not appear to be a contraindication to allogeneic HSCT.

UR - http://www.scopus.com/inward/record.url?scp=85006379890&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85006379890&partnerID=8YFLogxK

U2 - 10.1038/bmt.2016.259

DO - 10.1038/bmt.2016.259

M3 - Article

C2 - 27991895

AN - SCOPUS:85006379890

VL - 52

SP - 270

EP - 278

JO - Bone Marrow Transplantation

JF - Bone Marrow Transplantation

SN - 0268-3369

IS - 2

ER -