Invasive Fungal Disease in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation in China: A Multicenter Epidemiological Study (CAESAR 2.0)

Sun, Yuqian

Oral and Poster Abstracts
721. Allogeneic Transplantation: Conditioning Regimens, Engraftment, and Acute Toxicities: Poster I

Research, Epidemiology, Clinical Research

Chuan Li¹^*, Danping Zhu¹^*, Jia Chen²^*, Xiaoyu Zhu³, Nainong Li⁴, Weijie Cao, MD⁵^*, Zhongming Zhang⁶^*, Yehui Tan⁷^*, Xiaoxia Hu⁸^*, Hailong Yuan⁹^*, Xiaosheng Fang¹⁰^*, Yue Yin¹¹^*, Hongtao Wang¹²^*, Nan Li¹³^*, Xiao Jun Huang¹ and Yuqian Sun¹^*

¹Peking University People’s Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
²The First Affiliated Hospital of Soochow University, Suzhou, China
³Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
⁴Hematopoietic Stem Cell Transplantation Center, Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Department of Hematology, Fujian Medical University Union Hospital, Fuzhou, China
⁵Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
⁶Department of Hematology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
⁷the first affiliated hospital of jilin university, Changchun, China
⁸Shanghai Institute of Hematology, State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
⁹The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
¹⁰Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
¹¹Peking University First Hospital, Beijing, China
¹²Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, China
¹³Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China

Background: The widespread use of mold-active antifungal prophylaxis in recent years has altered the epidemiology of invasive fungal disease (IFD) following allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, large-scale studies on IFD epidemiology with the use of mold-active prophylaxis are lacking. Therefore, an updated investigation into the epidemiology of IFD in China is necessary. This study (China Assessment of Antifungal Therapy in Hematological Diseases, CAESAR 2.0) aimed to provide updated epidemiological data on IFD in patients undergoing allo-HSCT.

Methods: This multicenter, retrospective, observational study was conducted at 12 allo-HSCT centers in China. We retrospectively reviewed adult patients who underwent allo-HSCT between January 2021 and December 2021. Patients with a prior IFD before allo-HSCT or those who did not receive antifungal prophylaxis were excluded from the analysis. IFD was diagnosed according to the 2019 criteria of the European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC/MSG). Follow-up was completed by December 31, 2022. All patients were monitored up for at least one year or until death before the last follow-up.

Results: We reviewed a total of 2015 patients, including 1301 (64.57%) haploidentical stem cell transplantations, 435 (21.59%) sibling donor transplantations, 157 (7.79%) unrelated donor transplantations, and 122 (6.05%) cord blood transplantations. The most common antifungal prophylaxis used was voriconazole (44.37%), followed by posaconazole (31.71%), echinocandins (15.78%), fluconazole (6.2%), itraconazole (1.59%), and amphotericin (0.35%). IFD was documented in 201 (11.0%) patients, including 24 (10.9%) proven cases, 99 (44.8%) probable cases, and 98 (44.3%) possible cases. The cumulative incidence of IFD (proven, probable, and possible) one year after allo-HSCT was 11%. The most common site of infection was the lungs (82.81%), followed by the bloodstream (11.76%). Pathogens were identified in 33.48% of IFD cases, mainly Candida (13.12%), Mucor (8.14%), Aspergillus (7.69%), and Pneumocystis jirovecii (3.62%). The IFD-attributable mortality rate was 50.59%, and the one-year overall survival rate for patients with IFD was 60.92%. Multivariate analysis identified the following factors associated with IFD: more than 2 comorbidities (hazard ratio [HR]=1.81; 95% confidence interval [CI]: 1 to 3.26 P=0.048), time of absolute neutrophil count (ANC) engraftment (HR=1.07; 95% CI: 1.03 to 1.12 P=0.002), acute graft-versus-host disease (aGVHD) grade 3-4 (HR=2.25; 95% CI: 1.58 to 3.2 P<0.001), chronic graft-versus-host disease [(cGVHD) moderate and severe] (HR=1.68; 95% CI: 1.15 to 2.45 P=0.008), Epstein-Barr virus (EBV) viremia (HR=1.69; 95% CI: 1.21 to 2.37 P=0.002) and cytomegalovirus (CMV) viremia (HR=1.42; 95% CI: 1.02 to 1.98 P=0.037).

Conclusions: Despite the use of mold-active antifungal prophylaxis, the risk of IFD after allo-HSCT remains high. The most common pathogens are Candida, Mucor, Aspergillus, and Pneumocystis jirovecii.

Disclosures: No relevant conflicts of interest to declare.

See more of: 721. Allogeneic Transplantation: Conditioning Regimens, Engraftment, and Acute Toxicities: Poster I
See more of: Oral and Poster Abstracts

<< Previous Abstract | Next Abstract >>

^*signifies non-member of ASH

2133 Invasive Fungal Disease in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation in China: A Multicenter Epidemiological Study (CAESAR 2.0)