Epidemiology of invasive fungal diseases in haematopoietic stem cell transplant recipients: preliminary analysis of a multicentre, prospective, observational study from Italy

Objectives: The purpose of our study was to describe the cur- rent epidemiology, incidence, risk factors and current diagnos- tic strategies for invasive fungal diseases (IFDs) in allogeneic hematopoietic stem cell transplant (HSCT). Methods: This prospective, observational, multicenter study involved 30 HSCT Centers from Italy, started in January 2008 and is ongoing. Each Center reported data on consecutive patients who underwent HSCT and data were collected until 1 year from transplant. The data collection is ongoing and pre- liminary data are now reported. Results: To date, the baseline characteristics are available for 691 patients. Of them, 71 patients (10.3%) had experienced a proven/probable IFD before HSCT. They were 53 (74.6%) inva- sive aspergillosis (IA), 12 invasive candidosis (IC) and 6 IFDs by other fungi. Out of 515 patients evaluable at 100 days from HSCT, 53 (10.3%) developed a proven/probable IFD (IA, 46 cases; IC 5 cases; other IFDs, 2 cases). Out of 348 patients evaluable for the follow-up from 100 to 180 days from HSCT, 15 (4.3%) devel- oped an IFD. Finally, 5 IFDs (2.6%) were documented among 190 patients evaluable for the follow-up from 180 to 365 days. Overall, according to these preliminary data, the incidence of IFDs at 1 year from HSCT seems higher than 15%. According to the data until now available at least 15% of patients with an IA diagnosed before HSCT experienced an infection recurrence within 100 days after transplant. Out of 58 cases of proven/prob- able IA documented after HSCT serum detection of Aspergillus galactomannan antigen contributed to the diagnosis in 45 cases (77.6%). At a preliminary analysis, the 3 months mortality rate for HSCT recipients with an IFD was lower than 30%. Conclusion: This is a prospective study on the “real life” epide- miology of IFDs in allogeneic HSCT population. The available data show that IA remains the most commonly identified IFD and rates of survival appear to have improved, compared with historical literature data.