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Large European study highlights the importance of post-HSCT prophylaxis in minimising candidaemia

April 24 2018

The use of antifungal prophylaxis has greatly reduced the incidence of candidaemia in patients undergoing allogeneic haematopoietic stem cell transplantation (alloHSCT). However, Candida infection can still happen; incidence, risk factors and outcomes of Candida infection have not been studied in the era of antifungal prophylaxis.

A retrospective study of all patients seen between 2000 and 2012 in member centres of the European Society for Blood and Marrow Transplantation was conducted in order to assess the impact of candidaemia in patients with a first alloHSCT. Complete data were available for 28793 patients; deep Candida infection by day 100 were diagnosed in 2.1% of cases; 1.2% of cases had candidaemia. Nonrelapse mortality was 22.5% for patients with candidaemia vs. 13.5% in those without.

Risk factors associated with a higher risk of candidaemia were: female sex, total body irradiation, use of cord blood or bone marrow (vs. peripheral blood) as source of stem cells, T-cell depletion and acute graft vs. host disease.

In conclusion, use of prophylaxis has reduced the incidence of candidaemia in alloHSCT recipients; however, it is still associated with increased mortality despite the availability of newer antifungal agents.