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| Risk of Non-Candida Invasive Fungal Infections in Allogeneic Bone Marrow Transplant Patients who Received Infliximab to Control Severe Graft v. Host Disease |
| Category:
M. Mycology, Including Resistance and Mechanisms of Action of Antifungals |
| Presentation Time: Sunday, 8:45 a.m. - 9:00 a.m. |
F. M. MARTY1, S. J. LEE 1,2, E. P. ALYEA 1,2, R. J. SOIFFER 1,2, J. H. ANTIN 1,2, L. R. BADEN 1,2;
1Brigham & Women's Hospital, Boston, MA, 2Dana-Farber Cancer Institute, Boston, MA. |
| Presentation Number: M-1234 |
| Keyword:
invasive fungal infection, infliximab, aspergillus |
| Background: Graft v. Host Disease (GvHD) is a common complication of Allogeneic Bone Marrow Transplantation (AlloBMT). In patients with severe or refractory disease, off-label use of infliximab was employed to attempt control. We determined if infliximab use in this population was associated with an increased risk of non-Candida invasive fungal infections (IFI). Methods: All records of patients who received an AlloBMT at BWH–DFCI in 2000-2001 were reviewed. Detailed analysis of medical records of patients who developed Grade III-IV GvHD was performed. Our AlloBMT database was correlated with pathology, infection control and microbiology databases. IFI were defined according to the 2002 EORTC/NIAID international consensus. Results: 270 AlloBMT were done during the study period: 200 patients received myeloablative AlloBMT, 70 received non-myeloablative AlloBMT. 147 (54%) developed GvHD, 52 (19%) were grade III-IV. 11 patients received infliximab for treatment of grade III-IV GvHD: 8 were gastrointestinal, 2 skin and 1 liver predominant. 16 of 270 (6%) patients developed an IFI. 13/16 cases were in patients with any GvHD, 10/16 cases in those with grade III-IV GvHD. Of the 11 treated with infliximab, 2 died within 1 week of initiating this therapy due to complications from GvHD; of the remaining 9 patients, 6 (67%) developed an IFI. In patients with grade III-IV GvHD, the risk of developing an IFI in those who received infliximab (6/11) was significantly higher than those who did not (4/41) [RR 5.59, 95% CI 1.91-16.4; p=0.003]. Conclusion: Infliximab use in AlloBMT patients with severe GvHD is associated with a high IFI risk. Confounding by indication could not be completely excluded. Preemptive antifungal therapy directed against filamentous fungi should be strongly considered in this high-risk subpopulation. |
| Commercial Relationship: F.M. Marty, None. |
| IDTravelGrant: True |
| PresentationPref: No Preference |
| NoOffLabel: True |
| AuthorizedPCAwardAmount: 1500 |
| AuthorizedIDTravelGrantAmount: 1000 |
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