PMID- 12393425
OWN - NLM
STAT- MEDLINE
DCOM- 20030128
LR  - 20220409
IS  - 0006-4971 (Print)
IS  - 0006-4971 (Linking)
VI  - 100
IP  - 13
DP  - 2002 Dec 15
TI  - Invasive aspergillosis in allogeneic stem cell transplant recipients: changes in 
      epidemiology and risk factors.
PG  - 4358-66
AB  - The incidence of postengraftment invasive aspergillosis (IA) in hematopoietic 
      stem cell transplant (HSCT) recipients increased during the 1990s. We determined 
      risks for IA and outcomes among 1682 patients who received HSCTs between January 
      1993 and December 1998. Risk factors included host variables (age, underlying 
      disease), transplant variables (stem cell source), and late complications (acute 
      and chronic graft-versus-host disease [GVHD], receipt of corticosteroids, 
      secondary neutropenia, cytomegalovirus [CMV] disease, and respiratory virus 
      infection). We identified risk factors associated with IA early after 
      transplantation (<or= 40 days) and after engraftment (41-180 days). Older patient 
      age was associated with an increased risk during both periods. Chronic 
      myelogenous leukemia (CML) in chronic phase was associated with low risk for 
      early IA compared with other hematologic malignancies, aplastic anemia, and 
      myelodysplastic syndrome. Multiple myeloma was associated with an increased risk 
      for postengraftment IA. Use of human leukocyte antigen (HLA)-matched related (MR) 
      peripheral blood stem cells conferred protection against early IA compared with 
      use of MR bone marrow, but use of cord blood increased the risk of IA early after 
      transplantation. Factors that increased risks for IA after engraftment included 
      receipt of T cell-depleted or CD34-selected stem cell products, receipt of 
      corticosteroids, neutropenia, lymphopenia, GVHD, CMV disease, and respiratory 
      virus infections. Very late IA (> 6 months after transplantation) was associated 
      with chronic GVHD and CMV disease. These results emphasize the postengraftment 
      timing of IA; risk factor analyses verify previously recognized risk factors 
      (GVHD, receipt of corticosteroids, and neutropenia) and uncover the roles of 
      lymphopenia and viral infections in increasing the incidence of postengraftment 
      IA in the 1990s.
FAU - Marr, Kieren A
AU  - Marr KA
AD  - Fred Hutchinson Cancer Research Center Programs in Infectious Diseases and 
      Long-term Follow-up, Seattle, WA 98109, USA. kmarr@fhcrc.org
FAU - Carter, Rachel A
AU  - Carter RA
FAU - Boeckh, Michael
AU  - Boeckh M
FAU - Martin, Paul
AU  - Martin P
FAU - Corey, Lawrence
AU  - Corey L
LA  - eng
GR  - CA 15704/CA/NCI NIH HHS/United States
GR  - CA-18029/CA/NCI NIH HHS/United States
GR  - K08-A1571/PHS HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, P.H.S.
DEP - 20020822
PL  - United States
TA  - Blood
JT  - Blood
JID - 7603509
RN  - 0 (Adrenal Cortex Hormones)
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Adolescent
MH  - Adrenal Cortex Hormones/adverse effects
MH  - Adult
MH  - Age Factors
MH  - Aged
MH  - Aspergillosis/*epidemiology/etiology
MH  - Bone Marrow Transplantation/adverse effects
MH  - Child
MH  - Child, Preschool
MH  - Cohort Studies
MH  - Cytomegalovirus Infections/epidemiology/etiology
MH  - Female
MH  - Follow-Up Studies
MH  - Graft vs Host Disease/epidemiology
MH  - Hematologic Neoplasms/complications/*therapy
MH  - *Hematopoietic Stem Cell Transplantation/adverse effects
MH  - Humans
MH  - Immunosuppression Therapy/adverse effects
MH  - Immunosuppressive Agents/adverse effects
MH  - Incidence
MH  - Infant
MH  - Life Tables
MH  - Male
MH  - Middle Aged
MH  - Neutropenia/chemically induced/complications
MH  - Peripheral Blood Stem Cell Transplantation/adverse effects
MH  - Respiratory Tract Infections/epidemiology/etiology
MH  - Risk Factors
MH  - Survival Analysis
MH  - Time Factors
MH  - Transplantation Conditioning/adverse effects
MH  - Transplantation, Homologous
EDAT- 2002/10/24 04:00
MHDA- 2003/01/29 04:00
CRDT- 2002/10/24 04:00
PHST- 2002/10/24 04:00 [pubmed]
PHST- 2003/01/29 04:00 [medline]
PHST- 2002/10/24 04:00 [entrez]
AID - S0006-4971(20)53639-2 [pii]
AID - 10.1182/blood-2002-05-1496 [doi]
PST - ppublish
SO  - Blood. 2002 Dec 15;100(13):4358-66. doi: 10.1182/blood-2002-05-1496. Epub 2002 
      Aug 22.