Pedro Chorão, Pablo Granados, Pilar Calvillo-Batllés, Pedro Asensi, Marta Villalba, Aitana Balaguer-Roselló, Santiago de Cossio, Eva María González, María Dolores Gómez, Inés Gómez, Pilar Solves, Christian Tejada, Alberto Louro, Aurora Perla, Miguel Salavert, Javier de la Rubia, Miguel A Sanz, Jaime Sanz, Juan Montoro
{"title":"造血细胞移植后环磷酰胺联合泊沙康唑预防霉菌侵袭性真菌感染。","authors":"Pedro Chorão, Pablo Granados, Pilar Calvillo-Batllés, Pedro Asensi, Marta Villalba, Aitana Balaguer-Roselló, Santiago de Cossio, Eva María González, María Dolores Gómez, Inés Gómez, Pilar Solves, Christian Tejada, Alberto Louro, Aurora Perla, Miguel Salavert, Javier de la Rubia, Miguel A Sanz, Jaime Sanz, Juan Montoro","doi":"10.1016/j.jtct.2025.07.005","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Post-transplantation cyclophosphamide (PTCy) graft-versus-host disease (GVHD) prophylaxis regimens may increase the incidence of mold invasive fungal infections (IFI). Nevertheless, data on prophylaxis strategies and donor modalities are heterogenous and reports on posaconazole prophylaxis remain limited.</p><p><strong>Objectives: </strong>Characterize mold IFI incidence, risk factors and impact on outcomes in patients with hematologic malignancies undergoing PTCy-based HCT from matched sibling, matched unrelated, and haploidentical donors under posaconazole prophylaxis.</p><p><strong>Study design: </strong>Single-center retrospective study of mold IFI episodes in 435 patients undergoing HCT at a single institution. Daily 300 mg posaconazole dosage was given between days +7 and +90 or during GVHD on steroids.</p><p><strong>Results: </strong>Mold IFI affected 6% of patients (16 possible, eight probable, and two proven), with 73% breakthrough infections. Only Aspergillus spp. was identified. With a median onset of 88 days, the two-year cumulative incidence was 5.6% for overall and 2.1% for probable/proven mold IFI. Grade II-IV acute GVHD and higher HCT comorbidity index increased the risk for probable/proven mold IFI. One patient died from mold IFI, although 7% of deaths occurred with active mold IFI. Probable/proven mold IFI negatively impacted on the overall survival (OS).</p><p><strong>Conclusions: </strong>Mold IFI is an infrequent complication in allogeneic HCT with PTCy under posaconazole prophylaxis, although acute GVHD significantly increases its risk. While direct mortality is low, OS is negatively impacted by probable/proven mold IFI.</p>","PeriodicalId":23283,"journal":{"name":"Transplantation and Cellular Therapy","volume":" ","pages":""},"PeriodicalIF":3.6000,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"MOLD INVASIVE FUNGAL INFECTION IN HEMATOPOIETIC CELL TRANSPLANT WITH POST-TRANSPLANT CYCLOPHOSPHAMIDE AND POSACONAZOLE PROPHYLAXIS.\",\"authors\":\"Pedro Chorão, Pablo Granados, Pilar Calvillo-Batllés, Pedro Asensi, Marta Villalba, Aitana Balaguer-Roselló, Santiago de Cossio, Eva María González, María Dolores Gómez, Inés Gómez, Pilar Solves, Christian Tejada, Alberto Louro, Aurora Perla, Miguel Salavert, Javier de la Rubia, Miguel A Sanz, Jaime Sanz, Juan Montoro\",\"doi\":\"10.1016/j.jtct.2025.07.005\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Post-transplantation cyclophosphamide (PTCy) graft-versus-host disease (GVHD) prophylaxis regimens may increase the incidence of mold invasive fungal infections (IFI). Nevertheless, data on prophylaxis strategies and donor modalities are heterogenous and reports on posaconazole prophylaxis remain limited.</p><p><strong>Objectives: </strong>Characterize mold IFI incidence, risk factors and impact on outcomes in patients with hematologic malignancies undergoing PTCy-based HCT from matched sibling, matched unrelated, and haploidentical donors under posaconazole prophylaxis.</p><p><strong>Study design: </strong>Single-center retrospective study of mold IFI episodes in 435 patients undergoing HCT at a single institution. Daily 300 mg posaconazole dosage was given between days +7 and +90 or during GVHD on steroids.</p><p><strong>Results: </strong>Mold IFI affected 6% of patients (16 possible, eight probable, and two proven), with 73% breakthrough infections. Only Aspergillus spp. was identified. With a median onset of 88 days, the two-year cumulative incidence was 5.6% for overall and 2.1% for probable/proven mold IFI. Grade II-IV acute GVHD and higher HCT comorbidity index increased the risk for probable/proven mold IFI. One patient died from mold IFI, although 7% of deaths occurred with active mold IFI. Probable/proven mold IFI negatively impacted on the overall survival (OS).</p><p><strong>Conclusions: </strong>Mold IFI is an infrequent complication in allogeneic HCT with PTCy under posaconazole prophylaxis, although acute GVHD significantly increases its risk. While direct mortality is low, OS is negatively impacted by probable/proven mold IFI.</p>\",\"PeriodicalId\":23283,\"journal\":{\"name\":\"Transplantation and Cellular Therapy\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.6000,\"publicationDate\":\"2025-07-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Transplantation and Cellular Therapy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.jtct.2025.07.005\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"HEMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplantation and Cellular Therapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jtct.2025.07.005","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEMATOLOGY","Score":null,"Total":0}
MOLD INVASIVE FUNGAL INFECTION IN HEMATOPOIETIC CELL TRANSPLANT WITH POST-TRANSPLANT CYCLOPHOSPHAMIDE AND POSACONAZOLE PROPHYLAXIS.
Background: Post-transplantation cyclophosphamide (PTCy) graft-versus-host disease (GVHD) prophylaxis regimens may increase the incidence of mold invasive fungal infections (IFI). Nevertheless, data on prophylaxis strategies and donor modalities are heterogenous and reports on posaconazole prophylaxis remain limited.
Objectives: Characterize mold IFI incidence, risk factors and impact on outcomes in patients with hematologic malignancies undergoing PTCy-based HCT from matched sibling, matched unrelated, and haploidentical donors under posaconazole prophylaxis.
Study design: Single-center retrospective study of mold IFI episodes in 435 patients undergoing HCT at a single institution. Daily 300 mg posaconazole dosage was given between days +7 and +90 or during GVHD on steroids.
Results: Mold IFI affected 6% of patients (16 possible, eight probable, and two proven), with 73% breakthrough infections. Only Aspergillus spp. was identified. With a median onset of 88 days, the two-year cumulative incidence was 5.6% for overall and 2.1% for probable/proven mold IFI. Grade II-IV acute GVHD and higher HCT comorbidity index increased the risk for probable/proven mold IFI. One patient died from mold IFI, although 7% of deaths occurred with active mold IFI. Probable/proven mold IFI negatively impacted on the overall survival (OS).
Conclusions: Mold IFI is an infrequent complication in allogeneic HCT with PTCy under posaconazole prophylaxis, although acute GVHD significantly increases its risk. While direct mortality is low, OS is negatively impacted by probable/proven mold IFI.
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