造血干细胞移植后侵袭性真菌病临床特点及危险因素分析

马蕾; 钟沂芮; 刘林; 王利; 唐晓琼; 张红宾; 肖青; 牟佼

doi:10.16016/j.1000-5404.202004186

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造血干细胞移植后侵袭性真菌病临床特点及危险因素分析

专题报道:血液肿瘤诊治新策略与临床应用 | 更新时间：2026-01-09

- 造血干细胞移植后侵袭性真菌病临床特点及危险因素分析
- Clinical characteristics and risk factors of invasive fungal disease after hematopoietic stem cell transplantation: report of 233 cases
- 第三军医大学学报 2020年42卷第17期页码：1735-1742
- 作者机构：
- 作者简介：
- 基金信息：
  
  国家自然科学基金面上项目(81570109)
- DOI：10.16016/j.1000-5404.202004186
  中图分类号：
- 收稿：2020-04-17，
  
  纸质出版：2020-09-15
- 稿件说明：
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马蕾, 钟沂芮, 刘林, 等. 造血干细胞移植后侵袭性真菌病临床特点及危险因素分析[J]. 第三军医大学学报, 2020,42(17):1735-1742.

Lei MA, Yirui ZHONG, Lin LIU, et al. Clinical characteristics and risk factors of invasive fungal disease after hematopoietic stem cell transplantation: report of 233 cases[J]. Journal of Third Military Medical University, 2020, 42(17): 1735-1742.
马蕾, 钟沂芮, 刘林, 等. 造血干细胞移植后侵袭性真菌病临床特点及危险因素分析[J]. 第三军医大学学报, 2020,42(17):1735-1742. DOI： 10.16016/j.1000-5404.202004186.

Lei MA, Yirui ZHONG, Lin LIU, et al. Clinical characteristics and risk factors of invasive fungal disease after hematopoietic stem cell transplantation: report of 233 cases[J]. Journal of Third Military Medical University, 2020, 42(17): 1735-1742. DOI： 10.16016/j.1000-5404.202004186.

摘要

Abstract

Objective

To investigate the clinical characteristics of invasive fungal disease (IFD) after hematopoietic stem cell transplantation (HSCT) in the patients with hematological diseases

and analyze the risk factors of IFD after HSCT.

Methods

A retrospective study was conducted on 233 patients with hematological diseases treated by HSCT in our department from 2016 to 2018. Clinical data

including age

underlying diseases

complications

neutropenia time and other data were collected and analyzed for the clinical characteristics and risk factors of IFD among these patients.

Results

Among the 233 patients

41 were diagnosed as IFD

with a total incidence of 17.6%

and 7 cases (proven cases) of them were based on fungal detection and the other 34 cases (probable cases) on clinical manifestations. The mortality rate was 46.3% in the cohort. Meanwhile

out of the 41 proven/probable IFD

32 cases (78.0%) were breakthrough invasive fungal disease

with a total incidence of 13.7% and a mortality rate of 51.5%. The therapeutic effect on IFD before HSCT was related to the occurrence of IFD after the transplantation. Among the 41 IFD patients

19.5% were invasive candidiasis

80.5% were invasive mold disease

17.1% were bloodstream infection and 82.9% were pulmonary infection. The main pathogens detected were non-Candida albicans. Univariate analysis revealed that allogeneic HSCT

previous history of IFD

cytomegalovirus (CMV) infection

EB virus infection

underlying lung diseases

neutropenia >14 d and usage of high-dose glucocorticoid were risk factors of IFD

and multivariate analysis suggested that previous history of IFD

EB virus infection

underlying lung diseases

neutropenia >14 d and usage of high-dose glucocorticoid were independent risk factors of IFD. Among the allogeneic HSCT recipients

multivariate analysis suggested that chronic graft-versus-host disease (cGVHD) was also independent risk factors of IFD. The risk factor of bIFD in proven/probable IFD was neutropenia >14 d.

Conclusion

The incidence and mortality of invasive fungal diseases after HSCT are quite high

and the percentage of breakthrough IFD is also high. IFD after HSCT is mainly invasive mold disease and commonly in the lung. Previous history of IFD

EB virus infection

underlying lung diseases

neutropenia >14 d

and usage of high-dose glucocorticoid increase the risk of IFD after HSCT. cGVHD also contributes to the risk of IFD.

关键词

Keywords

references

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