Incidence, risk factors, and long-term outcome of acute leukemia patients with early candidemia after allogeneic stem cell transplantation. a study by the acute leukemia and infectious diseases working parties of EBMT

Research output: Contribution to journalArticle


  • Simone Cesaro
  • Gloria Tridello
  • Nicole Blijlevens
  • Per Ljungman
  • Mauricette Michallet
  • Alexander Martin
  • John A Snowden
  • Mohamad Mohty
  • Johan Maertens
  • Jacob Passweg
  • Eefke Petersen
  • Anne Nihtinen
  • Cecilia Isaksson
  • Noel Milpied
  • Pierre-simon Rohlich
  • Eric Deconinck
  • Charles Crawley
  • Marie-pierre Ledoux
  • Jennifer Hoek
  • Arnon Nagler
  • Jan Styczynski

Colleges, School and Institutes

External organisations

  • Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
  • Department of Hematology, Radboud University-Nijmegen Medical Centre, Nijmegen, The Netherlands.
  • Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.
  • Center for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom
  • Service d’ Hematologie, Centre Hospitalier Lyon Sud, Pierre-Bénite, France
  • Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom
  • Hospital Saint Antoine, University Pierre & Marie Curie, and INSERM UMRs, Paris, France
  • University Hospital Gasthuisberg, Leuven, Belgium
  • Department of Hematology, University Hospital, Basel, Switzerland.
  • Department of Obstetrics, University Medical Centre Utrecht, Utrecht, the Netherlands.
  • HUCH Comprehensive Cancer Center, Helsinki, Finland
  • Umea University Hospital, Sweden
  • CHU Bordeaux, Hôpital Haut-Leveque, Pessac, France.
  • CHU Nice–Hôpital de l’Archet
  • CHRU Besançon, Hematology, Inserm, France
  • Addenbrookes Hospital, Cambridge, United Kingdom
  • Hôpitaux Universitaires, Strasbourg, France
  • EBMT Data Office, Leiden, The Netherlands.
  • EBMT ALWP Office, Hospital Saint Antoine, Paris, France.
  • Department of Pediatric Hematology Oncology, Nicolaus Copernicus University Torun, Collegium Medicum, Bydgoszcz, Poland
  • Leicester Royal Infirmary


Background This study was performed to assess the incidence of and risk factors for Candida infection in the first 100 days after allogeneic hematopoietic stem cell transplantation (HSCT) and the impact on long-term survival. Methods We performed an outcome analysis of 28542 acute leukemia patients who underwent HSCT from 2000 to 2012. There were 347 patients with candidemia by day 100 and 28195 without candidemia or any other type of Candida infection. Results The incidence of candidemia by day 100 was 1.2% and occurred at a median of 22 days after HSCT. Higher 100-day nonrelapse mortality (NRM; hazards ratio [HR], 3.0, P < .0001) and lower 100-day overall survival (OS; HR, 2.5, P < .0001) were observed in patients with candidemia. The case fatality rate by day 100 in patients with candidemia was 22% (76/347). Factors associated with candidemia occurrence were female gender, bone marrow or cord blood stem cell source, T-cell depletion, use of total body irradiation, and acute graft vs host disease. Among the patients alive at day 100, the 5-year NRM and OS after a median follow-up of 5.6 years (95% confidence interval, 5.5 – 5.7) for patients with and without candidemia were 22.5% vs 13.5%, P < .0001 and 45.6% vs. 53.4%, P = .0003, respectively. In multivariate analysis, the occurrence of a candidemia episode by day 100 was an independent risk factor for higher NRM (HR, 1.7, P = .001) and lower OS (HR, 1.4, P = .001). Conclusions The early occurrence of candidemia after HSCT is still associated with higher NRM and lower short- and-long-term OS.


Original languageEnglish
Number of pages9
JournalClinical Infectious Diseases
Early online date22 Feb 2018
Publication statusE-pub ahead of print - 22 Feb 2018


  • hematopoietic stem cell transplantation, acute leukemia, Candida species infection, survival, nonrelapse mortality