Published in

Oxford University Press, Open Forum Infectious Diseases, 2023

DOI: 10.1093/ofid/ofad163

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Association Between Candidemia and Noninfectious Interstitial Pneumonia After Allogeneic Hematopoietic Cell Transplantation: JSTCT Transplant Complications Working Group

This paper was not found in any repository, but could be made available legally by the author.
This paper was not found in any repository, but could be made available legally by the author.

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Abstract

Abstract Background α-Mannan from Candida albicans reportedly induces Th17-mediated pulmonary graft-versus-host disease (GVHD) in a mouse model. This study aimed to evaluate the association between candidemia and non-infectious interstitial pneumonia (IP) in allogeneic hematopoietic cell transplantation (HCT) recipients. Methods By using a Japanese transplant registry database, we analyzed 9,143 pediatric and adult patients with hematological malignancies who underwent their first (n = 7,531) or second (n = 1,612) allogeneic HCT between 2009 and 2019. Results Non-infectious IP was observed in 694 patients at a median of 63 days (range 0-1,292) after HCT. Candidemia occurred in 358 patients at a median of 31 days (range, 0-903 days) after HCT. Candidemia treated as a time-dependent covariate was significantly associated with an increased incidence of non-infectious IP (hazard ratio [HR], 2.51; 95%CI, 1.48-4.25) along with total body irradiation (> 8Gy) (HR, 1.57; 95%CI, 1.18-2.10) and malignant lymphoma (vs. acute myeloid leukemia) (HR, 1.30; 95%CI, 1.004-1.69). On the other hand, prompt platelet recovery (HR, 0.58; 95%CI, 0.45-0.75) and acute lymphoblastic leukemia (vs. acute myeloid leukemia) (HR, 0.68; 95%CI, 0.49-0.94) were associated with a reduced incidence of non-infectious IP. The median survival after the development of non-infectious IP in patients with prior candidemia was significantly shorter than that in those without it (22 days vs. 59 days, P < 0.001). Conclusions Candidemia was associated with an increased incidence of non-infectious IP. The prognosis of non-infectious IP after candidemia was extremely poor.