The Clinical Analysis Of Invasive Fungal Disease After Allogeneic Hematopoietic Stem Cell Transplantation

Objective:To analyze the incidence rate, survival rate, diagnosis, treatment and effect, the site of infection, time of occurrence, clinical status, risk factors of invasive fungal disease(IFD) after allogeneic peripheral blood stem cell transplantation(allo-PBSCT) without in vitro T-cell depletion in patients. Method:One hundred and forty-two Patients who were underwent allo-PBSCT were selected from august 2006 to december 2010. Of 142 patients,74 were HLA full-matched transplants,68 were HLA haploidentical transplants,the follow-up time from 8 to 1591 days, Based on different types of transplant, patients were conditioned with busulfan and cyclophosphamide. High-risk patients of HLA full-matched and HLA haploidentical patients used Arabinosylcytosin.And 2 patients used irration. prophylaxis of graft versus host disease (GVHD) was used as Cyclosporine A+a short course of methotrexate+Dexamethasone, mycophnolate mofetil was add for 1 locus mismatched patients, mycophnolate mofetil, antithymocyte globulin and CD25 mono-colonal antibody were add for 2-3 loci mismatched patients. And analyse the incidence rate, survival rate, diagnosis, treatment and effect, the site of infection, time of occurrence, clinical status, risk factors of patients after transplantation. Results:Among 142 patiens,29 patients occurred IFD. The incidence rate is 20.4%, fatality rate is 34.5%(10/29). One year survival rate of IFD group is 63%, non-IFD group is 83.9%(p< 0.05). this comprised cases of proven, probable and possible IFD at rates of 3.4%(1/29),27.9%(8/29),69.0%(20/29). The total effective rate was 62.1%. The most common infection position of IFD was lung(82.8%), oral(10.3%) and intestinal(7.9%) are common infection position too. the mean time of IFD development was 174 days(-1-1300 days) after allo-PBSCT,2 patients occurred within the first month,9 patients occurred within the 100 days,24 patients occurred within the first year. By univariate analysis, age, sex, nation, underlying diseases, transplantation method, regarding conditioning regimens, HLA mismatch and acute GVHD were not associated with the occurrence of IFD. the status of disease, chronic extensive graft-versus-host disease(cGVHD) were closely associated with the occurrence of IFD(p< 0.05). Conclution:IFD is an important complication after allo-PBSCT, Compared with other units, the incidence rate of our units is not so high. The clinical diagnosis of IFD is difficult, the status of disease and chronic cGVHD are risk factors for IFD, so it is necessary to take intervention earlier.