Delayed engraftment with prolonged neutropenia is a major risk factor for IFI after HSCT. We hypothesized that the D-index, which quantifies both depth and duration of neutropenia, could help predict IFI.
We retrospectively reviewed 789 adults who underwent allogeneic HSCT at our institution from 1/1/2005 9/30/2015. Clinical data from the hospital transplant database and medical records were reviewed from the date of transplant through Day 100. The D-index was calculated as the area over the neutrophil curve until engraftment. IFI was defined using EORTC criteria.
There were 714 patients for analysis (Figure 1) whose characteristics are summarized in Table 1. Sixteen patients (2%) developed probable (11) or proven IFI (5). Median time to IFI presentation was 40 days (range 8-98) after HSCT. Most IFI cases were pulmonary (13/16). Proven IFI cases included: Aspergillus (2), Rhizopus (1), Mucor (1) and Lichtheimia (1). The duration of severe neutropenia (<100/mm3) was significantly longer in those with IFI than without (13 vs. 10, p =0.05). Median D-index for those with IFI was higher at 4293 daysneutrophil/µl compared to 3605 daysneutrophil/µl for those without IFI but was not statistically significant (p = 0.2).
Only 2% of patients developed IFI, likely due to use of mold-active azoles for prophylaxis in most patients. Mortality rate was significantly higher for those who had IFI. Both duration of severe neutropenia and D-index were greater in those with IFI, but the former may better predict the occurrence of IFI among allo-HSCT recipients during the first 100 days after transplant.
C. L. Abad,
R. Walker, None
W. Hogan, None
B. Lahr, None
A. Tande, None
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