Clinical features and risk factors for invasive fungal sinusitis after allogeneic hematopoietic stem cell transplantation
10.3760/cma.j.cn121090-20231009-00175
- VernacularTitle:血液病患者异基因造血干细胞移植后侵袭性真菌性鼻窦炎的临床特征及危险因素分析
- Author:
Haixia FU
1
;
Jiajia LI
;
Yuanyuan ZHANG
;
Yuqian SUN
;
Xiaodong MO
;
Tingting HAN
;
Jun KONG
;
Meng LYU
;
Wei HAN
;
Huan CHEN
;
Yuhong CHEN
;
Fengrong WANG
;
Chenhua YAN
;
Yao CHEN
;
Jingzhi WANG
;
Yu WANG
;
Lanping XU
;
Xiaojun HUANG
;
Xiaohui ZHANG
Author Information
1. 北京大学人民医院，北京大学血液病研究所，国家血液系统疾病临床医学研究中心，造血干细胞移植治疗血液病北京市重点实验室，北京 100044
- Keywords:
Allogeneic hematopoietic stem cell transplantation;
Fungal sinusitis;
Clinical characteristic;
Risk factor
- From:
Chinese Journal of Hematology
2024;45(1):22-27
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the clinical characteristics and outcomes of patients with invasive fungal sinusitis (invasive fungal rhinosinusitis, IFR) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and explored the risk factors for IFR after allo-HSCT.Methods:Nineteen patients with IFR after allo-HSCT at Peking University People’s Hospital from January 2012 to December 2021 were selected as the study group, and 95 patients without IFR after allo-HSCT during this period were randomly selected as the control group (1:5 ratio) .Results:Nineteen patients, including 10 males and 9 females, had IFR after allo-HSCT. The median age was 36 (10–59) years. The median IFR onset time was 68 (9–880) days after allo-HSCT. There were seven patients with acute myeloid leukemia, five with acute lymphoblastic leukemia, two with myelodysplastic syndrome, two with chronic myeloid leukemia, one with acute mixed-cell leukemia, one with multiple myeloma, and one with T-lymphoblastic lymph node tumor. There were 13 confirmed cases and 6 clinically diagnosed cases. The responsible fungus was Mucor in two cases, Rhizopus in four, Aspergillus in four, and Candida in three. Five patients received combined treatment comprising amphotericin B and posaconazole, one patient received combined treatment comprising voriconazole and posaconazole, nine patients received voriconazole, and four patients received amphotericin B. In addition to antifungal treatment, 10 patients underwent surgery. After antifungal treatment and surgery, 15 patients achieved a response, including 13 patients with a complete response and 2 patients with a partial response. Multivariate analysis revealed that neutropenia before transplantation ( P=0.021) , hemorrhagic cystitis after transplantation ( P=0.012) , delayed platelet engraftment ( P=0.008) , and lower transplant mononuclear cell count ( P=0.012) were independent risk factors for IFR after allo-HSCT. The 5-year overall survival rates in the IFR and control groups after transplantation were 29.00%±0.12% and 91.00%±0.03%, respectively ( P<0.01) . Conclusion:Although IFR is rare, it is associated with poor outcomes in patients undergoing allo-HSCT. The combination of antifungal treatment and surgery might be effective.
