Invasive Fungal Disease in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation in China: A Multicenter Epidemiological Study (CAESAR 2.0)

Chuan Li; Dan-Ping Zhu; Jia Chen; Xiao-Yu Zhu; Nai-Nong Li; Wei-Jie Cao; Zhong-Ming Zhang; Ye-Hui Tan; Xiao-Xia Hu; Hai-Long Yuan; Xiao-Sheng Fang; Yue Yin; Hong-Tao Wang; Nan Li; Xiao-Jun Huang; Yu-Qian Sun

doi:10.1093/cid/ciae612

Invasive Fungal Disease in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation in China: A Multicenter Epidemiological Study (CAESAR 2.0)

Clin Infect Dis. 2024 Dec 12:ciae612. doi: 10.1093/cid/ciae612. Online ahead of print.

Authors

Chuan Li¹, Dan-Ping Zhu¹, Jia Chen², Xiao-Yu Zhu³, Nai-Nong Li⁴, Wei-Jie Cao⁵, Zhong-Ming Zhang⁶, Ye-Hui Tan⁷, Xiao-Xia Hu⁸, Hai-Long Yuan⁹, Xiao-Sheng Fang¹⁰, Yue Yin¹¹, Hong-Tao Wang¹², Nan Li¹³, Xiao-Jun Huang¹, Yu-Qian Sun¹

Affiliations

¹ Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.
² The First Affiliated Hospital of Soochow University, Suzhou, China.
³ Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
⁴ Hematopoietic Stem Cell Transplantation Center, Fujian Institute of Hematology, Fujian Provincial Key Laboratory on Hematology, Department of Hematology, Fujian Medical University Union Hospital, Fuzhou, China.
⁵ Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
⁶ The first affiliated hospital of Guangxi Medical University, Nanning, China.
⁷ Department of Hematology, The First Affiliated Hospital of Jilin University, Changchun, China.
⁸ State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁹ The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Institute of Hematology, Urumqi, China.
¹⁰ Shandong First Medical University Affiliated Provincial Hospital, Jinan, China.
¹¹ Peking University First Hospital, Beijing, China.
¹² Department of Hematology, Shengjing Hospital of China Medical University, Shenyang, China.
¹³ Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China.

PMID: 39666951
DOI: 10.1093/cid/ciae612

Abstract

Background: This study (China Assessment of Antifungal Therapy in Hematological Diseases, CAESAR 2.0) aimed to provide updated epidemiological data on invasive fungal disease (IFD) in patients undergoing allogeneic stem cell transplantation (allo-HSCT).

Methods: This multicenter, real-world, observational study was conducted at 12 allo-HSCT centers in China between January 2021 and December 2021. Consecutive adult patients (≥18 years) who underwent allo-HSCT with antifungal prophylaxis were included. IFD was diagnosed according to the 2019 criteria of the European Organization for Research and Treatment of Cancer and Mycoses Study Group (EORTC/MSG). Follow-up was completed by December 31, 2022.

Results: A total of 2015 patients were collected. mold-active antifungal prophylaxis was used in 76.08% of patients, which included mainly voriconazole (44.37%) and posaconazole (31.71%). The cumulative incidence of IFD (proven and probable) at 1 year after allo-HSCT was 6.3%. Pathogens were identified in 47.97% of IFD cases and mainly included Candida spp. (17.89%), Mucorales (13.01%), Aspergillus spp. (8.94%), and Pneumocystis jirovecii (6.5%). Multivariate analysis identified the following factors associated with IFD: disease at advanced stage (hazard ratio [HR]= 2.55; 95% confidence interval [CI]: 1.58-4.12 P<0.001), absolute neutrophil count (ANC) engraftment (≤28 days) (HR=0.37; 95% CI: 0.15-0.92 P=0.032), platelet (PLT) engraftment (≤28 days) (HR=0.41; 95% CI: 0.27-0.62 P<0.001) and acute graft-versus-host disease grade III-IV (HR=2.97; 95% CI: 1.97-4.49 P<0.001). The IFD-attributable mortality rate was 48.28%.

Conclusions: Despite the widespread use of mold-active prophylaxis, the risk of IFD after allo-HSCT remains high. The most common pathogens are Candida spp., Mucorales, Aspergillus spp., and Pneumocystis jirovecii.

Keywords: Allogeneic stem cell transplantation (allo-HSCT); China; Invasive fungal disease (IFD).

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