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Risk factors for invasive fungal infections in adult patients with hematological malignancies and/or stem cell transplant: a systematic review and meta-analysis

Summary

This comprehensive study analyzed multiple research papers to identify which patients with blood cancers or stem cell transplants are most likely to develop serious fungal infections. The researchers found that patients who previously had a stem cell transplant, those taking corticosteroids, and those with low white blood cell counts face the highest risks. Importantly, the study showed that using antifungal medications as a preventive treatment significantly reduces infection risk in these vulnerable patients.

Background

Invasive fungal infections (IFI) remain a significant cause of morbidity and mortality in patients with hematological malignancies and those undergoing hematopoietic stem cell transplantation (HSCT). Despite advances in antifungal prophylaxis, vulnerable populations including acute leukemia patients and HSCT recipients continue to face high risk. Understanding the specific risk factors for IFI is essential for improving prevention and treatment strategies.

Objective

To perform a systematic review and meta-analyses to identify and quantify factors associated with invasive fungal infections in adult patients with hematological malignancies and/or HSCT, using standardized definitions for IFI.

Results

Among 12,624 references identified, 69 studies reporting 2,917 IFI cases were included in the systematic review, with 20 studies included in PP-IFI meta-analysis. Independent risk factors included previous allo-HSCT (aHR 3.21), acute GvHD ≥2 (aHR 2.59), corticosteroids (aOR 2.84), and T-cell depleting agents (aOR 2.73). Haploidentical donor transplantation significantly increased risk (aHR 2.41). Antifungal prophylaxis was protective (aOR 0.20).

Conclusion

Key risk factors for IFI in hematological patients include previous allo-HSCT, prolonged neutropenia, corticosteroid use, and relapsed/refractory AML status. In the allo-HSCT population, heightened vigilance is warranted for patients with haploidentical donors, acute GvHD grade ≥2, or receiving T-cell depleting agents. Antifungal prophylaxis effectively reduces IFI risk and should be considered for high-risk populations.
  • Published in:Scientific Reports,
  • Study Type:Systematic Review and Meta-analysis,
  • Source: PMID: 40841820, DOI: 10.1038/s41598-025-16066-6
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