Incidence, Patterns, and Outcomes of Fungal Infections in Patients With Graft Versus Host Disease Requiring Systemic Steroids Following Allogeneic Hematopoietic Cell Transplantation: A Systematic Review and Meta Analysis.
Muhammad Kashif Amin, Areeba Ismail, Muhammad Shahzou Shah et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis pooled findings from four studies involving 1,141 patients with graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation who required systemic steroids. The pooled incidence of invasive fungal infections (IFIs) was 8.0% (95% CI: 6.0%-10.0%). Aspergillosis was the most frequently reported infection, with a pooled incidence of 5% (95% CI: 3.0%-9.0%). Pooled IFI-related mortality was 3% across the cohort and 39.4% among patients with established or probable IFIs. Incidence estimates varied across GVHD subgroups and prophylaxis regimens.
Key findings
- Overall pooled IFI incidence was 8.0% (95% CI: 6.0%-10.0%; I² = 49.5%).
- Aspergillosis had a pooled incidence of 5% (95% CI: 3.0%-9.0%; I² = 70.3%).
- IFI incidence was 10.0% in acute GVHD and 9.0% in chronic GVHD.
- IFI-related mortality was 3% in the full cohort and 39.4% among patients with established or probable IFIs.
Why it matters
These pooled estimates quantify the burden of IFIs in a population exposed to systemic steroids after transplantation and show that infection-related mortality remains substantial once IFI is established or probable. The findings can inform risk discussions and highlight the importance of continued attention to fungal infection prevention and recognition, while the variability between studies cautions against treating pooled estimates as precise predictions for every patient.
What to keep in mind
Only four studies were included, and several pooled estimates showed substantial heterogeneity, limiting the precision and generalisability of the results.