INVASIVE FUNGAL DISEASES IN ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION RECIPIENTS WITH HODGKIN’S LYMPHOMA
Author(s): ,
Marina Popova
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Yuliya Rogacheva
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Alisa Volkova
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Inna Markova
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Anastasya Frolova
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Aleksandr Shvetcov
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Ilya Nikolaev
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Oleg Goloshchapov
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Svetlana Ignatieva
Affiliations:
I.I. Mechnikov North-Western State Medical University,Saint Petersburg,Russian Federation
,
Tatyana Bogomolova
Affiliations:
I.I. Mechnikov North-Western State Medical University,Saint Petersburg,Russian Federation
,
Andrey Kozlov
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Kirill Lepik
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Zalyalov Yuriy
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Liliya Stelmakh
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Elena Kondakova
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Asmik Gevorgian
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Anastasiya Beynarovich
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Evgeniya Borzenkova
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Elena Darskaya
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Marya Vladovskaya
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Sergey Bondarenko
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Ivan Moiseev
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Vadim Baykov
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Natalya Mikhailova
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Ludmila Zubarovskaya
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
,
Nicolay Klimko
Affiliations:
I.I. Mechnikov North-Western State Medical University,Saint Petersburg,Russian Federation
Boris Afanasyev
Affiliations:
Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation, First Pavlov State Medical University of St. Petersburg,Saint Petersburg,Russian Federation
EHA Library. Rogacheva Y. Jun 15, 2019; 266902; PS1285
Yuliya Rogacheva
Yuliya Rogacheva
Contributions
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Abstract

Abstract: PS1285

Type: Poster Presentation

Presentation during EHA24: On Saturday, June 15, 2019 from 17:30 - 19:00

Location: Poster area

Background

Data on invasive fungal disease (IFD) in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients with relapsed/refractory Hodgkin’s lymphoma (r/r HL) are limited. Outcome of allo-HSCT in patients with prior IFD is still a subject of controversy.

Aims
The aim is to study the epidemiology of IFD in allo-HSCT recipients with r/r HL.

Methods
Single center prospective observational study included 86 patients with classical r/r HL who underwent allo-HSCT from 2002 to 2018. The median age was 27 (13-49) y.o., children (<18 yo) – 13% (n=11). Allo-HSCT from MUD was performed in 45,4% (n=39), MRD – 24,4% (n=21), MMUD – 15,1% (n=13), haplo – 15,1% (n=13), with RIC (100%) and predominantly PTCY-based GvHD prophylaxis (71%). Primary antifungal prophylaxis was fluconazole in 85%, secondary – voriconazole (100%). EORTC/MSG 2008 criteria for diagnosis and response to therapy were used. In pts with CT-scan lung lesions before allo-HSCT bronchoscopy with BAL was used. “Active IFD” means IFD diagnosed just before HSCT. Median follow-up time was 12 months [1-71].

Results

Incidence of pre-existing IFD in allo-HSCT recipients with r/r HL was 12,8% (n=11). All cases of IFD prior to HSCT were invasive aspergillosis (IA) with lungs involvement. Antifungal therapy before allo-HSCT was used in 81,8% pts with median duration – 2 months. Complete response to antifungal therapy was in 45,4% pts, partial response or stabilization – 36,4%, and 18,2% pts had an “active IFD”. After allo-HSCT all pts received voriconazole as an antifungal therapy or secondary prophylaxis. Cumulative incidence of relapse or progression of IA after allo-HSCT was 18,2% with the median 49 day [19-79] of onset after HSCT, which were successfully treated with voriconazole. Incidence of IFD after allo-HSCT for naïve patients was 17,6% (n=13/74). Etiology of IFD after allo-HSCT was IA – 69%, invasive candidiasis (IC) – 15%, mucormycosis – 8%, and combined IFD caused by Aspergillus fumigatus + Rhizopus stolonifer - 8%. The median day of onset of IFD after allo-HSCT was day+ 114 [1-489]. The main site of infection were lungs (88%), the main clinical symptom – febrile fever (100%). Antifungal therapy was following: voriconazole – 59%, micafungin – 17%, posaconazole – 8%, lipid amphotericin B – 8% and combination lipid amphotericin B with caspofungin – 8%. Overall survival (OS) at 12 weeks from the IFD diagnosis after allo-HSCT was 80%. The 2-year OS in children and adult with r/r HL after allo-HSCT was 73,3%. Development of IFD after allo-HSCT do not decrease the 2-year OS rate (69,2% vs 74%, p=0,77). The impact of prior IFD on 2-year OS in allo-HSCT recipients was not statistically significant in all group (63,6% vs 74,7%, p=0,47), and separately in children and adults.

Conclusion

Incidence of pre-existing IFD in children and adults with r/r Hodgkin’s lymphoma allo-HSCT recipients was 12,8%. Incidence of IFD after allo-HSCT in naïve patients with Hodgkin’s lymphoma was 17,6%. The major etiology agent as before as after allo-HSCT were Aspergillus spp. IFD was a late complication after allo-HSCT. Despite the high incidence of IFD before or after allo-HSCT didn’t influence the outcome in children and adults with r/r Hodgkin lymphoma.

Session topic: 30. Infectious diseases

Keyword(s): Allogeneic hematopoietic stem cell transplant, Fungal infection, Hodgkin's lymphoma, Invasive aspergillosis

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