229 Association of Mannose Binding Lectin (MBL) Levels and Invasive Fungal Disease (IFD) in Hematologic Malignancy Patients Undergoing Hematopoietic Stem Cell Transplantation (HSCT) or Receiving Chemotherapy

Track: Contributed Abstracts
Wednesday, February 13, 2013, 6:45 PM-7:45 PM
Hall 1 (Salt Palace Convention Center)
Mary Mansour Riwes, DO , College of Medicine, Division of Hematology/Oncology, University of Florida, Gainesville, FL
Helen Leather, BPharm , College of Medicine, Division of Hematology/Oncology, University of Florida, Gainesville, FL
Dan Neal, M.S. , Department of Biostatistics, University of Florida, Gainesville, FL
Clayton Bennett , College of Medicine, Division of Hematology/Oncology, University of Florida, Gainesville, FL
Michele Sugrue , College of Medicine, Division of Hematology/Oncology, University of Florida, Gainesville, FL
Christina Cline , College of Medicine, Division of Hematology/Oncology, University of Florida, Gainesville, FL
Joe Stokes , College of Medicine, Division of Hematology/Oncology, University of Florida, Gainesville, FL
John Hiemenz, MD , College of Medicine, Division of Hematology/Oncology, University of Florida, Gainesville, FL
Jack Hsu, MD , College of Medicine, Division of Hematology/Oncology, University of Florida, Gainesville, FL
John R Wingard, MD , College of Medicine, Division of Hematology/Oncology, University of Florida, Gainesville, FL

Background: IFD is a major cause of morbidity and mortality after intensive chemotherapy and HSCT in patients with hematologic malignancies. MBL is a member of the C-type lectin superfamily of microbe pattern recognition molecules.  Several studies have suggested an association of MBL levels below 1,000 ng/ml with a variety of infectious complications in cancer therapy, but there are conflicting data. The aim of this study was to investigate the association between low MBL levels and the development of IFD in patients with hematologic malignancies undergoing chemotherapy or HSCT.

Methods: We conducted an analysis of MBL levels among patients enrolled in a previous prospective cohort study. Serum samples from 152 patients with hematologic malignancies who received chemotherapy and/or HSCT between December 2001 and November 2006 were collected before or early after treatment initiation and stored at -70oC. Quantification of MBL levels was performed by a sandwich-ELISA assay (Viracor-IBT laboratories, Mo). Patients were followed for 6 months and scored as developing proven or probable IFD or not.  The relationship between MBL level and developing proven or probable IFD was assessed using chi-square and Mann-Whitney tests. Survival analyses including logistic regression and Cox Proportional Hazards models were used to test the effect of MBL level and IFD status on overall survival and whether MBL level has an effect on IFD-free survival time.

Results: Forty-five of 152 patients (29.6 %) developed IFD during the 6 months follow-up period of which 21 (46.7% of IFD cases and 13.8% of patients) were proven or probable IFD. Fifty-nine of 152 patients (38.8%) had MBL levels below 1,000 ng/ml. The rates of proven or probable IFD in patients with MBL levels below and above 1,000 ng/mL were 11.9 % and 15.1 % respectively (P=.579). Mean MBL levels were lower in the IFD-free group (2085 vs 2398, p=.429). MBL levels below 1,000 ng/ml were not a predictor of death (P=.233). Mean IFD- free survival times in patients with MBL levels below and above 1,000 ng/ml were 20 weeks and 21 weeks respectively (p=.423). As expected, proven or probable IFD was associated with death (P<.0001).

Conclusions: Our findings indicate that low MBL levels were not associated with an increased risk of developing proven or probable IFD or overall survival in patients with hematologic malignancy.

 

No IFD

Proven or Probable IFD

MBL>1000

79 (84.9%)

14 (15.1%)

MBL<1000

52 (88.1%)

7 (11.9%)

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