6079 - Invasive fungal diseases in patients with Hodgkin’s lymphoma before and after allogeneic hematopoietic stem cell transplantation

Background

This study focuses on epidemiology of IFD before and after allo-HSCT in children and adults with Hodgkin’s lymphoma (HL).

Methods

Single center prospective observational study included 86 patients with classical r/r HL who received allo-HSCT from 2002 to 2018. The median age was 27 (13-49) y.o., children (<18 yo) – 13% (n = 11). Allo-HSCT from MUD was performed in 45,4% (n = 39), MRD – 24,4% (n = 21), MMUD – 15,1% (n = 13), haplo – 15,1% (n = 13), with RIC (100%) and predominantly PTCY-based GvHD prophylaxis (71%). Primary antifungal prophylaxis was flu in 85%, secondary – vori (100%). EORTC/MSG 2008 criteria for diagnosis and response to therapy were used. Median follow-up time was 12 months [1-71].

Results

Incidence of IFD before allo-HSCT was 12,8% (n = 11). Antifungal therapy before allo-HSCT was used in 81,8% pts with median duration – 2 months. Complete response to antifungal therapy was in 45,4% pts, partial response or stabilization – 36,4%, and 18,2% pts had an “active IFD”. Cumulative incidence of relapse or progression of IA after allo-HSCT was 18,2% with the median 49 day [19-79] after HSCT, which were successfully treated with vori in post HSCT period. Incidence of IFD after allo-HSCT for naïve patients was 17,6% (n = 13/74). Etiology of IFD after allo-HSCT was IA – 69%, invasive candidiasis – 15%, mucormycosis – 8% and 8% combined IFD caused by Asp. fumigatus + Rhizopus stolonifer. The median day of onset of IFD after allo-HSCT was day+ 114 [1-489]. Antifungal therapy was used in all patients: vori – 59%, mica– 17%, posa – 8%, L-AmB – 8% and combination L-AmB with caspo – 8%. Overall survival (OS) at 12 weeks from the diagnosis of IFD after allo-HSCT was 80%. The 2-year OS in children and adult with HL after allo-HSCT was 73,3%. Development of IFD after allo-HSCT do not decrease the 2-year OS rate (69,2% vs 74%, p = 0,77, figure 1a). The impact of prior IFD on 2-year OS in allo-HSCT recipients was not statistically significant in all group (63,6% vs 74,7%, p = 0,47, figure 1b), and separately in children and adults.

Conclusions

Incidence of IFD before allo-HSCT was 12,8%. Incidence of IFD after allo-HSCT was 17,6%. Despite the high incidence IFD before or after allo-HSCT didn’t influence the outcome in children and adults with Hodgkin lymphoma.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.