Invasive Fungal Infections in Recipients of Hematopoietic Stem Cell Transplants: Results From a Single Center Retrospective Analysis

Background:The purpose of our study was to evaluate the incidence and outcome of Invasive Fungal Infections (IFI) among patients who underwent autologous or allogeneic Hematopoietic Stem Cell Transplantation (HSCT) at our BMT-Unit.Methods:This cohort-retrospective study,conducted during 02/1994 to 09/2012,involved HSCT patients admitted to our BMT-Unit,who developed IFI.The IFI were classified according to the modified EORTC/MSG criteria.Results:Among  369 patients who underwent HSCT(88 allogeneic HSCT recipients and 281 autologous HSCT recipients),IFI occurred in 38 patients(overall incidence 10,3 %). 34 episodes (9,2 % of all patients)were due to molds,and  4 (1 %)were due to yeasts. 27 episodes (30,6 %) occurred among the allogeneic HSCT recipients, and 11(3,9%)occurred among the autologous HSCT recipients (RR 7.83, 95%CI 3.92-16.21).Etiological agents were Aspergillus (31 episodes), Candida(3 episodes), Rhodotorula(1 episode), Fusarium(1 episode), Scedosporium (1 episode), Zygomycosis(1 episode).The incidence of Aspergillosis was 25 % and 3,2 % among allogeneic and autologous HSCT recipients respectively (RR 7.80, 95%CI 3.58-17.75). The incidence of Candidiasis was  2,2 % and  0,3 % among allogeneic and autologous HSCT recipients respectively (RR 6.38, 95%CI 0.45-177.57). The overall mortality rate for IFI  was 5,7 % among  allogeneic  HSCT recipients  and  1 % among autologous recipients  (RR 5.32,95%CI 1.13-27.79) , whereas the attributable mortality rate for IFI  registered in our population was 21 % (18,5 % for allogeneic HSCT recipients and 27,2 % for autologous HSCT recipients (RR 0.67,95% CI 0.16-3.34). The attributable mortality rate for aspergillosis was 22,6 %(18,2 % and  33,3 % for allogeneic and autologous HSCT recipients,respectively,RR 0.54,95%CI 0.12-2.81),and the rate for Candida IFI was 0 %. Conclusions:IFI represents a common complication for allogeneic HSCT recipients.Aspergillosis is the most frequently detected IFI in these patients. Conversely, autologous HSCT recipients rarely develop aspergillosis. Candidemia was observed less often than aspergillosis among both allogeneic and autologous HSCT recipients.