Validation of a multivariable prediction model for post-engraftment invasive fungal disease in 465 adult allogeneic hematopoietic stem cell transplant recipients.

BACKGROUND: Recently, we reported a simple prognostic score for post-engraftment invasive fungal disease (IFD) obtained in 404 adult allogeneic hematopoietic stem cell transplant (alloSCT) (training cohort).

OBJECTIVES: We aim to validate this score in an external cohort assessing the 1-year cumulative incidence (CI) of post-engraftment IFD. Additionally, we analyze the type of IFD, and incidence of IFD according to type of prophylaxis.

PATIENTS/METHODS: We included 465 consecutive adult recipients surviving >40 days who engrafted and were discharged without prior IFD (median age 45 years, range, 14-69).

RESULTS: Patients classified as low-risk, 139; intermediate-risk, 162; and high-risk, 164 (35% vs 27% in the training-cohort, p=.03). The CI of probable/proven IFD in the validation-cohort was 8% vs 11% in the training-cohort (p=.006). The only voriconazole prophylaxis used in the training-cohort was 100mg/12h, 65% vs 27% in the validation-cohort, but 38% received 200mg/12h. Thus the validation-cohort showed a lower CI of IFD (p=.009). The post-engraftment IFD score was validated, showing a CI of IFD for low-, intermediate-, and high-risk of 3%, 6%, and 14%, respectively (p<0.001).

CONCLUSION: To our knowledge, this is the first prognostic index to predict the occurrence of post-engraftment IFD after alloSCT that has been validated in an external cohort. This article is protected by copyright. All rights reserved.