C Li, R Ma, Q Wang, Y He, X Y Luo, D P Zhu, X D Mo, Y Wang, L P Xu, X H Zhang, K Y Liu, X J Huang, Y Q Sun
{"title":"【异基因造血干细胞移植后侵袭性毛霉病的临床特点及预后】。","authors":"C Li, R Ma, Q Wang, Y He, X Y Luo, D P Zhu, X D Mo, Y Wang, L P Xu, X H Zhang, K Y Liu, X J Huang, Y Q Sun","doi":"10.3760/cma.j.cn112137-20250226-00456","DOIUrl":null,"url":null,"abstract":"<p><p><b>Objective:</b> To explore the clinical characteristics and prognostic factors of patients with invasive mucormycosis (IM) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). <b>Methods:</b> The clinical data of IM patients after allo-HSCT in Peking University People's Hospital from January 1, 2010 to December 31, 2021 were retrospectively collected and followed up until October 1, 2022. The survival curve was plotted by the Kaplan-Meier method. The multivariate Cox regression model was used to analyze the risk factors affecting the death of patients. <b>Results:</b> Among the 50 patients with IM, 39 were male (78.0%) and 11 were female (22.0%), with a median age [<i>M</i>(<i>Q</i><sub>1</sub>,<i>Q</i><sub>3</sub>)] of 35.5 (22.0, 46.8) years. Twenty-one cases (42.0%) were confirmed in diagnosis and 29 cases (58.0%) were clinically diagnosed. Pathogens included <i>Rhizopus</i> spp (<i>n</i>=26, 52.0%), <i>Mucor</i> spp (<i>n</i>=15, 30.0%), <i>Rhizomucor</i> spp (<i>n</i>=5, 10.0%) and <i>Lichtheimia ramosa</i> spp (<i>n</i>=4, 8.0%). Clinical types included pulmonary mucormycosis (<i>n</i>=35, 70.0%), rhinocerebral mucormycosis (<i>n</i>=6, 12.0%), disseminated mucormycosis (<i>n</i>=5, 10.0%), gastrointestinal mucormycosis (<i>n</i>=2, 4.0%) and cutaneous mucormycosis (<i>n</i>=2, 4.0%). The time [<i>M</i>(<i>Q</i><sub>1</sub>, <i>Q</i><sub>3</sub>)] of IM infection after allo-HSCT was 119 (56, 241) days. Forty-five patients (90%) received antifungal treatment and the effective rate was 53.3% (24/45) after 6 weeks of treatment. Among the 50 IM patients, 41 cases (82.0%) died, among which 21 cases (42.0%) died of IM. The median follow-up time was 2 169 days (95%<i>CI:</i> 1 264-3 073 days), and the 1-year survival rate was 25.8% and the median survival time was 51 days (95%<i>CI</i>: 0-124 days). Comorbidities before allo-HSCT (<i>HR</i>=2.103, 95%<i>CI</i>:1.056-4.191, <i>P</i>=0.034), non-engraftment of platelets (<i>HR</i>=2.213, 95%<i>CI</i>:1.149-4.264, <i>P</i>=0.018), and platelets<30×10<sup>9</sup>/L at infection (<i>HR</i>=2.129, 95%<i>CI</i>: 1. 093-4.150, <i>P</i>=0.026) were the influencing factors of patient death. <b>Conclusions:</b> <i>Rhizopus</i> spp is the predominant pathogen of IM after allo-HSCT, primarily affecting the lungs. The prognosis of IM patients after allo-HSCT is poor. Comorbidities before allo-HSCT, non-engraftment of platelets and platelets<30×10<sup>9</sup>/L at infection may affect the survival time of the patients.</p>","PeriodicalId":24023,"journal":{"name":"Zhonghua yi xue za zhi","volume":"105 32","pages":"2731-2737"},"PeriodicalIF":0.0000,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"[Clinical characteristics and outcomes of invasive mucormycosis after allogeneic hematopoietic stem cell transplantation].\",\"authors\":\"C Li, R Ma, Q Wang, Y He, X Y Luo, D P Zhu, X D Mo, Y Wang, L P Xu, X H Zhang, K Y Liu, X J Huang, Y Q Sun\",\"doi\":\"10.3760/cma.j.cn112137-20250226-00456\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p><b>Objective:</b> To explore the clinical characteristics and prognostic factors of patients with invasive mucormycosis (IM) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). <b>Methods:</b> The clinical data of IM patients after allo-HSCT in Peking University People's Hospital from January 1, 2010 to December 31, 2021 were retrospectively collected and followed up until October 1, 2022. The survival curve was plotted by the Kaplan-Meier method. The multivariate Cox regression model was used to analyze the risk factors affecting the death of patients. <b>Results:</b> Among the 50 patients with IM, 39 were male (78.0%) and 11 were female (22.0%), with a median age [<i>M</i>(<i>Q</i><sub>1</sub>,<i>Q</i><sub>3</sub>)] of 35.5 (22.0, 46.8) years. Twenty-one cases (42.0%) were confirmed in diagnosis and 29 cases (58.0%) were clinically diagnosed. Pathogens included <i>Rhizopus</i> spp (<i>n</i>=26, 52.0%), <i>Mucor</i> spp (<i>n</i>=15, 30.0%), <i>Rhizomucor</i> spp (<i>n</i>=5, 10.0%) and <i>Lichtheimia ramosa</i> spp (<i>n</i>=4, 8.0%). Clinical types included pulmonary mucormycosis (<i>n</i>=35, 70.0%), rhinocerebral mucormycosis (<i>n</i>=6, 12.0%), disseminated mucormycosis (<i>n</i>=5, 10.0%), gastrointestinal mucormycosis (<i>n</i>=2, 4.0%) and cutaneous mucormycosis (<i>n</i>=2, 4.0%). The time [<i>M</i>(<i>Q</i><sub>1</sub>, <i>Q</i><sub>3</sub>)] of IM infection after allo-HSCT was 119 (56, 241) days. Forty-five patients (90%) received antifungal treatment and the effective rate was 53.3% (24/45) after 6 weeks of treatment. Among the 50 IM patients, 41 cases (82.0%) died, among which 21 cases (42.0%) died of IM. The median follow-up time was 2 169 days (95%<i>CI:</i> 1 264-3 073 days), and the 1-year survival rate was 25.8% and the median survival time was 51 days (95%<i>CI</i>: 0-124 days). Comorbidities before allo-HSCT (<i>HR</i>=2.103, 95%<i>CI</i>:1.056-4.191, <i>P</i>=0.034), non-engraftment of platelets (<i>HR</i>=2.213, 95%<i>CI</i>:1.149-4.264, <i>P</i>=0.018), and platelets<30×10<sup>9</sup>/L at infection (<i>HR</i>=2.129, 95%<i>CI</i>: 1. 093-4.150, <i>P</i>=0.026) were the influencing factors of patient death. <b>Conclusions:</b> <i>Rhizopus</i> spp is the predominant pathogen of IM after allo-HSCT, primarily affecting the lungs. The prognosis of IM patients after allo-HSCT is poor. Comorbidities before allo-HSCT, non-engraftment of platelets and platelets<30×10<sup>9</sup>/L at infection may affect the survival time of the patients.</p>\",\"PeriodicalId\":24023,\"journal\":{\"name\":\"Zhonghua yi xue za zhi\",\"volume\":\"105 32\",\"pages\":\"2731-2737\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-08-26\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Zhonghua yi xue za zhi\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.3760/cma.j.cn112137-20250226-00456\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Zhonghua yi xue za zhi","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3760/cma.j.cn112137-20250226-00456","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
[Clinical characteristics and outcomes of invasive mucormycosis after allogeneic hematopoietic stem cell transplantation].
Objective: To explore the clinical characteristics and prognostic factors of patients with invasive mucormycosis (IM) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods: The clinical data of IM patients after allo-HSCT in Peking University People's Hospital from January 1, 2010 to December 31, 2021 were retrospectively collected and followed up until October 1, 2022. The survival curve was plotted by the Kaplan-Meier method. The multivariate Cox regression model was used to analyze the risk factors affecting the death of patients. Results: Among the 50 patients with IM, 39 were male (78.0%) and 11 were female (22.0%), with a median age [M(Q1,Q3)] of 35.5 (22.0, 46.8) years. Twenty-one cases (42.0%) were confirmed in diagnosis and 29 cases (58.0%) were clinically diagnosed. Pathogens included Rhizopus spp (n=26, 52.0%), Mucor spp (n=15, 30.0%), Rhizomucor spp (n=5, 10.0%) and Lichtheimia ramosa spp (n=4, 8.0%). Clinical types included pulmonary mucormycosis (n=35, 70.0%), rhinocerebral mucormycosis (n=6, 12.0%), disseminated mucormycosis (n=5, 10.0%), gastrointestinal mucormycosis (n=2, 4.0%) and cutaneous mucormycosis (n=2, 4.0%). The time [M(Q1, Q3)] of IM infection after allo-HSCT was 119 (56, 241) days. Forty-five patients (90%) received antifungal treatment and the effective rate was 53.3% (24/45) after 6 weeks of treatment. Among the 50 IM patients, 41 cases (82.0%) died, among which 21 cases (42.0%) died of IM. The median follow-up time was 2 169 days (95%CI: 1 264-3 073 days), and the 1-year survival rate was 25.8% and the median survival time was 51 days (95%CI: 0-124 days). Comorbidities before allo-HSCT (HR=2.103, 95%CI:1.056-4.191, P=0.034), non-engraftment of platelets (HR=2.213, 95%CI:1.149-4.264, P=0.018), and platelets<30×109/L at infection (HR=2.129, 95%CI: 1. 093-4.150, P=0.026) were the influencing factors of patient death. Conclusions:Rhizopus spp is the predominant pathogen of IM after allo-HSCT, primarily affecting the lungs. The prognosis of IM patients after allo-HSCT is poor. Comorbidities before allo-HSCT, non-engraftment of platelets and platelets<30×109/L at infection may affect the survival time of the patients.
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