Risk Factors for the Development of Invasive Fungal Infection and Cytomegalovirus Infection in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

Objective: Invasive fungal infections (IFI) and Cytomegalovirus (CMV) infections are seen in gradually increasing frequencies in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. This study aimed to evaluate the risk factors for the development of IFI and CMV infections in allo-HSCT recipients. Materials and Methods: The risk factors for IFI and CMV infection development before and after transplantation were analyzed in 379 allo-HSCT patients, 370 of whom underwent transplantation between June 1, 2005, and May 17, 2012, at the Stem Cell Transplantation Unit of the Hematology Department, Ankara University Faculty of Medicine. The characteristics of allo-HSCT recipients and donors and the data about the allo-HSCT process were retrospectively evaluated. Results: According to the EORTC/MSG criteria, probable and/or proven IFI was identified in 63 allo-HSCT patients (16.6%). In the univariate analysis, IFI development was significantly associated with conditioning regimen type (myeloablative vs. reduced intensity), graft-versus-host disease (GvHD) prophylaxis, CMV infection occurrence, frequency and timing, thrombocyte engraftment, and mortality. In the multivariate logistic regression analysis, CMV infection and the absence of thrombocyte engraftment were found to increase the risk of IFI development by 3.66-fold (95% confidence interval [CI]: 1.696–7.937, p=0.001) and 2.45-fold (95% CI: 1.043–5.785, p=0.040), respectively. CMV infection occurred in 243 allo-HSCT patients (64.1%). In the univariate analysis, CMV infection development was significantly associated with recipient and donor age, acute and chronic GvHD, IFI occurrence, neutrophil and thrombocyte engraftment, and transplantation-related mortality. However, none of these associations remained statistically significant in the multivariate logistic regression analysis. Conclusion: The identification of CMV infection and the absence of thrombocyte engraftment as significant risk factors for IFI development in allo-HSCT recipients underscores the need for tailored preventive strategies. A more personalized approach to post-transplant care, incorporating early detection and targeted interventions, could enhance patient outcomes and reduce IFI-related complications.