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Prepublished online as a Blood First Edition Paper on July 10, 2003; DOI 10.1182/blood-2003-01-0267. This Article Full Text (PDF) All Versions of this Article: 2003-01-0267v1 102/8/2768    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Marty, F. M Articles by Baden, L. R Search for Related Content PubMed PubMed Citation Articles by Marty, F. M Articles by Baden, L. R Related Collections Related Letter in Blood Online Social Bookmarking                   What's this? Submitted January 29, 2003 Accepted June 25, 2003 Infliximab use in patients with severe graft-versus-host disease and other emerging risk factors of non-Candida invasive fungal infections in allogeneic hematopoietic stem cell transplant recipients. A cohort study Francisco M Marty*, Stephanie J Lee, Michelle M Fahey, Edwin P Alyea, Robert J Soiffer, Joseph H Antin, and Lindsey R Baden Division of Infectious Diseases, Brigham & Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA Hematopoietic Stem-Cell Transplantation Service, Dana-Farber Cancer Institute, Boston, MA, USA * Corresponding author; email: fmarty{at}partners.org. Acute graft-versus-host disease (GVHD) is a common complication of allogeneic hematopoietic stem-cell transplantation (HSCT). It has been proposed that TNF- blockade with infliximab may be an effective treatment of severe (grade III-IV) GVHD. We determined if infliximab use in this high-risk population was associated with an additional increased risk of non-Candida invasive fungal infections (IFI). Records of the 2000-2001 HSCT cohort at our institution were reviewed. Fifty-three of 264 evaluable patients (20%) developed severe GVHD and 11 of these 53 (21%) received infliximab for treatment. Proven or probable IFI was documented in 10/53 (19%) patients with severe GVHD (incidence rate of 0.99 cases/1000 GVHD-patient-days). When stratified by infliximab use, 5/11 infliximab recipients developed an IFI (6.78 cases/1000 GVHD-patient-days), compared to 5/42 IFI cases among non-recipients (0.53 cases/1000 GVHD-patient-days). In a time-dependent Cox regression model among patients with severe GVHD, the adjusted IFI hazard ratio of infliximab exposure was 13.6 (p=0.004, 95% CI 2.29-80.2). We conclude that infliximab administration is associated with a significantly increased risk of non-Candida IFI in HSCT recipients with severe GVHD disease. Preemptive systemic antifungal therapy against molds should be considered in patients who develop severe GVHD after HSCT if infliximab is used. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Letter in Blood Online: Fatal case of protothecosis in a hematopoietic stem cell transplant recipient after infliximab treatment for graft-versus-host disease Jad A. Khoury, Eric R. Dubberke, and Steven M. Devine Blood 2004 104: 3414-3415. [Full Text] [PDF] This article has been cited by other articles: J. E. Levine, S. Paczesny, S. Mineishi, T. Braun, S. W. Choi, R. J. Hutchinson, D. Jones, Y. Khaled, C. L. Kitko, D. Bickley, et al. Etanercept plus methylprednisolone as initial therapy for acute graft-versus-host disease Blood, February 15, 2008; 111(4): 2470 - 2475. 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