Incidence, patterns, and outcomes of fungal infections in patients with GvHD

Results from a systematic review and meta-analysis evaluating the incidence, patterns, and outcomes of invasive fungal infections (IFIs) in patients with graft-versus-host disease (GvHD) receiving systemic corticosteroids following allogeneic hematopoietic stem cell transplantation (allo-HSCT) were published in Transplantation Proceedings by Amin et al. The analysis included four studies and a total of 1,141 patients.

Key data: The pooled overall incidence of IFIs was 8.0% (95% confidence interval [CI], 6.0–10.0; I² = 49.5%), with aspergillosis being the most reported fungal infection (5%; 95% CI, 3.0–9.0; I² = 70.3%). Pooled IFI incidence was 10.0% (95% CI, 8.0–13.0; I² = 0%) among patients with acute GvHD (aGvHD) and 9.0% in those with chronic GvHD (cGvHD; 95% CI, 3.0–24.0; I² = 83.7%). Estimated pooled overall IFI-related mortality was 3% (95% CI, 2.0–4.0; I² = 0.0%), while pooled IFI-related mortality among established or probable IFI cases was 39.4% (95% CI, 25.5–55.3). A subgroup analysis by follow-up duration showed higher IFI-related mortality in studies with ≥12 months of follow-up (4%) compared with those having <12 months (3%). IFI incidence did not differ significantly between antifungal prophylaxis strategies.

Key learning: This study highlights the ongoing burden of IFIs in patients with GvHD receiving corticosteroids, particularly those with aGvHD and longer follow-up, reinforcing the need for individualized prevention strategies in this high-risk population.