Impact of Invasive Fungal Infections on Mortality, Length of Hospital Stay, and Costs in Allogeneic Hematopoietic Stem Cell Transplant Patients

Jenny Cai, Angela Prehn, Haran Schlamm, Massimiliano Mucci, Aimee Ferraro
2014 Biology of Blood and Marrow Transplantation  
challenge. Despite advances in allo-HSCT reducing risk of morbidity and mortality, relapse has not altered significantly. We performed a single institution review of relapse following allo-HSCT in patients with AL examining salvage therapy and characteristics of long term survivors. Methods: All adult patients who proceeded to an allo-HSCT for AL from 1998-2012 (n¼100) were reviewed. 24 relapsed following allo-HSCT and a detailed review of salvage treatments and outcomes was made. Probability
more » ... overall survival (POS) and 95% confidence interval (CI) were calculated by actuarial method. Results: The 5 year POS of the 100 patients with AL proceeding to allo-HSCT was 71 % (CI 61-80%). Of 24 relapsing after allo-HSCT, 17 had initial diagnosis AML, and 7 ALL. The AML group median age was 49y (range 22-65), 53% male. Ten patients received sibling donors, 6 unrelated donors and 1 patient a related haplo-identical donor. Relapses were mostly systemic (14) and extra medullary (EM) 3 of the 17 cases. Median time to relapse was 13 months (3-57). Salvage treatments were: second allo-HSCT +/-chemotherapy (chemo) (n¼5); donor lymphocyte infusion (DLI) +/-chemo (n¼5); chemo +/-withdrawal of immunosuppression (WI) (n¼4); or palliative/supportive care (n¼3). Ten patients (57%) achieved complete response (CR), and CR was maintained by 8 patients (47%), with a median follow up 34 months (range 8-66). All deaths (n¼9) were due to disease. All 3 patients with EM relapse are in ongoing remission. In the ALL group (n¼7) median age was 22y (range 19-52), 57% of male. 3 were sibling donor transplants, 3 unrelated and 1 patient received a double cord. Relapse was systemic in 5 patients, and EM in 2. Median time to relapse was 13 months (range 3-57). Salvage treatments comprised: chemo +/-WI (n¼3), second allo-HSCT +/-salvage chemo (n¼2), DLI +/-salvage chemo (n¼1), with 1 patient receiving novel monoclonal antibody therapy. Three patients achieved a CR, however, all died, 2 of disease progression. Two patients remain alive in PR with ongoing salvage treatment to be determined. Conclusions: Despite advances in allo-HSCT, long term survival outcomes for patients with ALL who relapse after allo-HSCT remain poor. However, in contrast, for patients with AML who relapse, durable long-term remissions can be achieved with salvage therapy (with and without second allo-HSCT) with almost half of our patients (47%) in ongoing CR at a median of 34 months (range 8-66). As shown in other studies EM relapse, may be salvaged with good long term results.
doi:10.1016/j.bbmt.2013.12.364 fatcat:7scsdkq4kfabtd5sieti2bugxm