Epidemiology and Risk Factors for Invasive Fungal Diseases among Allogeneic Hematopoietic Stem Cell Transplant Recipients in Korea

Results of “RISK” Study

Jae Ki Choi, Sung Yeon Cho, Sung Soo Yoon, Joon Ho Moon, Sung Han Kim, Je Hwan Lee, Jinseok Kim, June Won Cheong, Jun Ho Jang, Bo Jeong Seo, Young Joo Kim, Hye Jung Lee, Juneyoung Lee, Jong Wook Lee, Dong Gun Lee

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Incidence, epidemiology, and risk factors of invasive fungal diseases (IFDs) in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients can vary from different cohorts and countries. Therefore, we performed a nationwide study to establish a proper antifungal prophylaxis strategies based on risk stratifications of IFDs after all-HSCT in Korea (RISK study). This was a multicenter, retrospective, and observational study in Korea. All consecutive adult patients who received allo-HSCT in 2013 were included. The 12-month cumulative incidence of proven/probable IFDs (PP-IFDs) was calculated during the early (days 0 to 40), late (days 41 to 100), and very late (days 101 to 365) phases after allo-HSCT. Cox proportional hazard regression analysis was performed to identify risk factors for PP-IFDs at each phase. A total 521 allo-HSCT cases in 518 patients were analyzed. Overall cumulative incidence of PP-IFDs were 4.09% (95% confidence interval [CI], 2.38 to 5.81), 7.38% (95% CI, 5.09 to 9.67), and 15.36% (95% CI, 12.04 to 18.68) at the early, late and very phases, respectively. In multiple Cox regression analysis, variables were associated with PP-IFDs in each period were identified. Variables associated with early phase include underlying pulmonary diseases, underlying nonmalignant stable or chronic disease at allo-HSCT, unrelated or family mismatched donor, and prolonged neutropenia. Variables associated with the late phase include high ferritin level at the time point of allo-HSCT, use of secondary immunosuppressive agents due to refractory graft-versus-host disease (GVHD), and cytomegalovirus reactivation. For the very late phase, variables were secondary neutropenia, severe chronic GVHD, and use of TNF-alpha inhibitor for refractory GVHD. This study revealed the high cumulative incidence of IFDs in Korean allo-HSCT recipients, which have distinct risk factors in each phase after allo-HSCT. Our findings indicate that tailored antifungal prophylaxis is necessary for high-risk patients. Clinicians should consider using mold-active antifungal prophylaxis in allo-HSCT recipients who have high risks at different treatment period.

Original languageEnglish
Pages (from-to)1773-1779
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Volume23
Issue number10
DOIs
Publication statusPublished - 2017 Oct 1

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Mycoses
Korea
Hematopoietic Stem Cells
Epidemiology
Transplants
Graft vs Host Disease
Incidence
Confidence Intervals
Regression Analysis
Transplant Recipients
Immunosuppressive Agents
Ferritins
Neutropenia
Cytomegalovirus
Lung Diseases
Multicenter Studies
Observational Studies
Chronic Disease
Fungi
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Hematology
  • Transplantation

Cite this

Choi, Jae Ki ; Cho, Sung Yeon ; Yoon, Sung Soo ; Moon, Joon Ho ; Kim, Sung Han ; Lee, Je Hwan ; Kim, Jinseok ; Cheong, June Won ; Jang, Jun Ho ; Seo, Bo Jeong ; Kim, Young Joo ; Lee, Hye Jung ; Lee, Juneyoung ; Lee, Jong Wook ; Lee, Dong Gun. / Epidemiology and Risk Factors for Invasive Fungal Diseases among Allogeneic Hematopoietic Stem Cell Transplant Recipients in Korea : Results of “RISK” Study. In: Biology of Blood and Marrow Transplantation. 2017 ; Vol. 23, No. 10. pp. 1773-1779.
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abstract = "Incidence, epidemiology, and risk factors of invasive fungal diseases (IFDs) in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients can vary from different cohorts and countries. Therefore, we performed a nationwide study to establish a proper antifungal prophylaxis strategies based on risk stratifications of IFDs after all-HSCT in Korea (RISK study). This was a multicenter, retrospective, and observational study in Korea. All consecutive adult patients who received allo-HSCT in 2013 were included. The 12-month cumulative incidence of proven/probable IFDs (PP-IFDs) was calculated during the early (days 0 to 40), late (days 41 to 100), and very late (days 101 to 365) phases after allo-HSCT. Cox proportional hazard regression analysis was performed to identify risk factors for PP-IFDs at each phase. A total 521 allo-HSCT cases in 518 patients were analyzed. Overall cumulative incidence of PP-IFDs were 4.09{\%} (95{\%} confidence interval [CI], 2.38 to 5.81), 7.38{\%} (95{\%} CI, 5.09 to 9.67), and 15.36{\%} (95{\%} CI, 12.04 to 18.68) at the early, late and very phases, respectively. In multiple Cox regression analysis, variables were associated with PP-IFDs in each period were identified. Variables associated with early phase include underlying pulmonary diseases, underlying nonmalignant stable or chronic disease at allo-HSCT, unrelated or family mismatched donor, and prolonged neutropenia. Variables associated with the late phase include high ferritin level at the time point of allo-HSCT, use of secondary immunosuppressive agents due to refractory graft-versus-host disease (GVHD), and cytomegalovirus reactivation. For the very late phase, variables were secondary neutropenia, severe chronic GVHD, and use of TNF-alpha inhibitor for refractory GVHD. This study revealed the high cumulative incidence of IFDs in Korean allo-HSCT recipients, which have distinct risk factors in each phase after allo-HSCT. Our findings indicate that tailored antifungal prophylaxis is necessary for high-risk patients. Clinicians should consider using mold-active antifungal prophylaxis in allo-HSCT recipients who have high risks at different treatment period.",
author = "Choi, {Jae Ki} and Cho, {Sung Yeon} and Yoon, {Sung Soo} and Moon, {Joon Ho} and Kim, {Sung Han} and Lee, {Je Hwan} and Jinseok Kim and Cheong, {June Won} and Jang, {Jun Ho} and Seo, {Bo Jeong} and Kim, {Young Joo} and Lee, {Hye Jung} and Juneyoung Lee and Lee, {Jong Wook} and Lee, {Dong Gun}",
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Choi, JK, Cho, SY, Yoon, SS, Moon, JH, Kim, SH, Lee, JH, Kim, J, Cheong, JW, Jang, JH, Seo, BJ, Kim, YJ, Lee, HJ, Lee, J, Lee, JW & Lee, DG 2017, 'Epidemiology and Risk Factors for Invasive Fungal Diseases among Allogeneic Hematopoietic Stem Cell Transplant Recipients in Korea: Results of “RISK” Study', Biology of Blood and Marrow Transplantation, vol. 23, no. 10, pp. 1773-1779. https://doi.org/10.1016/j.bbmt.2017.06.012

Epidemiology and Risk Factors for Invasive Fungal Diseases among Allogeneic Hematopoietic Stem Cell Transplant Recipients in Korea : Results of “RISK” Study. / Choi, Jae Ki; Cho, Sung Yeon; Yoon, Sung Soo; Moon, Joon Ho; Kim, Sung Han; Lee, Je Hwan; Kim, Jinseok; Cheong, June Won; Jang, Jun Ho; Seo, Bo Jeong; Kim, Young Joo; Lee, Hye Jung; Lee, Juneyoung; Lee, Jong Wook; Lee, Dong Gun.

In: Biology of Blood and Marrow Transplantation, Vol. 23, No. 10, 01.10.2017, p. 1773-1779.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Epidemiology and Risk Factors for Invasive Fungal Diseases among Allogeneic Hematopoietic Stem Cell Transplant Recipients in Korea

T2 - Results of “RISK” Study

AU - Choi, Jae Ki

AU - Cho, Sung Yeon

AU - Yoon, Sung Soo

AU - Moon, Joon Ho

AU - Kim, Sung Han

AU - Lee, Je Hwan

AU - Kim, Jinseok

AU - Cheong, June Won

AU - Jang, Jun Ho

AU - Seo, Bo Jeong

AU - Kim, Young Joo

AU - Lee, Hye Jung

AU - Lee, Juneyoung

AU - Lee, Jong Wook

AU - Lee, Dong Gun

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Incidence, epidemiology, and risk factors of invasive fungal diseases (IFDs) in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients can vary from different cohorts and countries. Therefore, we performed a nationwide study to establish a proper antifungal prophylaxis strategies based on risk stratifications of IFDs after all-HSCT in Korea (RISK study). This was a multicenter, retrospective, and observational study in Korea. All consecutive adult patients who received allo-HSCT in 2013 were included. The 12-month cumulative incidence of proven/probable IFDs (PP-IFDs) was calculated during the early (days 0 to 40), late (days 41 to 100), and very late (days 101 to 365) phases after allo-HSCT. Cox proportional hazard regression analysis was performed to identify risk factors for PP-IFDs at each phase. A total 521 allo-HSCT cases in 518 patients were analyzed. Overall cumulative incidence of PP-IFDs were 4.09% (95% confidence interval [CI], 2.38 to 5.81), 7.38% (95% CI, 5.09 to 9.67), and 15.36% (95% CI, 12.04 to 18.68) at the early, late and very phases, respectively. In multiple Cox regression analysis, variables were associated with PP-IFDs in each period were identified. Variables associated with early phase include underlying pulmonary diseases, underlying nonmalignant stable or chronic disease at allo-HSCT, unrelated or family mismatched donor, and prolonged neutropenia. Variables associated with the late phase include high ferritin level at the time point of allo-HSCT, use of secondary immunosuppressive agents due to refractory graft-versus-host disease (GVHD), and cytomegalovirus reactivation. For the very late phase, variables were secondary neutropenia, severe chronic GVHD, and use of TNF-alpha inhibitor for refractory GVHD. This study revealed the high cumulative incidence of IFDs in Korean allo-HSCT recipients, which have distinct risk factors in each phase after allo-HSCT. Our findings indicate that tailored antifungal prophylaxis is necessary for high-risk patients. Clinicians should consider using mold-active antifungal prophylaxis in allo-HSCT recipients who have high risks at different treatment period.

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