A RECENT multicenter study in China provides critical insights into the persistent threat of invasive fungal disease (IFD) among patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). Despite advancements in antifungal prophylaxis, the risk of IFD remains significant, with serious implications for patient outcomes.
Conducted across 12 allo-HSCT centers in China, the CAESAR 2.0 study observed 2,015 patients who received mold-active antifungal prophylaxis during 2021. Agents like voriconazole (44.37%) and posaconazole (31.71%) were widely used. Yet, the cumulative one-year incidence of proven or probable IFD reached 6.3%, emphasizing the challenge of fungal infections in this vulnerable group.
The study identified Candida spp. (17.89%), Mucorales (13.01%), Aspergillus spp. (8.94%), and Pneumocystis jirovecii (6.5%) as the most common pathogens. Alarmingly, the attributable mortality rate for IFD cases stood at a staggering 48.28%.
Key risk factors included advanced disease stage (HR=2.55), delayed neutrophil or platelet engraftment (HR=0.37 and HR=0.41, respectively), and severe acute graft-versus-host disease (HR=2.97). These findings underscore the urgent need for improved diagnostic tools, therapeutic approaches, and individualized prophylaxis strategies in this high-risk population.
Healthcare professionals should remain vigilant, as fungal infections can critically affect patient survival despite aggressive preventive measures.
Reference: Li C et al. Invasive Fungal Disease in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation in China: A Multicenter Epidemiological Study (CAESAR 2.0). Clin Infect Dis. 2024;ciae612.
Anaya Malik | AMJ
