Pagano et al identified risk factors for invasive fungal infections (IFI) for patients receiving a stem cell transplant. A patient at risk may benefit from more aggressive management. The authors are members of SEIFEM (Sorveglianza Epidemiologica Infezioni Fungine nelle Emopatie Maligne) Group in Italy.
Patient selection: autologous or allogeneic hematopoietic stem cell transplant
Intermediate risk for IFI after autologous stem cell transplant is associated with:
(1) previous invasive fungal infection
(2) > 3 lines of therapy
(3) prolonged neutropenia (absolute neutrophil count < 500 per µL for > 14 days)
(4) corticosteroid therapy
(5) colonization with Candida species
(6) previous therapy with fludarabine
(7) advanced disease status
Intermediate risk for IFI after allogeneic stem cell transplant:
(1) matched sibling donor AND complete remission AND no GVFD AND no previous IFI
High risk for IFI after allogeneic stem cell transplant:
(1) donor other than matched sibling
(2) GVHD requiring high-dose steroids
(3) history of previous IFI
(4) active hematopoietic malignancy
