Epidemiology and Risk Factors for Invasive Fungal Diseases among Allogeneic Hematopoietic Stem Cell Transplant Recipients in Korea: Results of “RISK” Study

Jae Ki Choi, Sung Yeon Cho, Sung Soo Yoon, Joon Ho Moon, Sung Han Kim, Je Hwan Lee, Jin Seok Kim, June Won Cheong, Jun Ho Jang, Bo Jeong Seo, Young Joo Kim, Hye Jung Lee, Juneyoung Lee, Jong Wook Lee, Dong Gun Lee

Research output: Contribution to journalArticlepeer-review

29 Citations (Scopus)


Incidence, epidemiology, and risk factors of invasive fungal diseases (IFDs) in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients can vary from different cohorts and countries. Therefore, we performed a nationwide study to establish a proper antifungal prophylaxis strategies based on risk stratifications of IFDs after all-HSCT in Korea (RISK study). This was a multicenter, retrospective, and observational study in Korea. All consecutive adult patients who received allo-HSCT in 2013 were included. The 12-month cumulative incidence of proven/probable IFDs (PP-IFDs) was calculated during the early (days 0 to 40), late (days 41 to 100), and very late (days 101 to 365) phases after allo-HSCT. Cox proportional hazard regression analysis was performed to identify risk factors for PP-IFDs at each phase. A total 521 allo-HSCT cases in 518 patients were analyzed. Overall cumulative incidence of PP-IFDs were 4.09% (95% confidence interval [CI], 2.38 to 5.81), 7.38% (95% CI, 5.09 to 9.67), and 15.36% (95% CI, 12.04 to 18.68) at the early, late and very phases, respectively. In multiple Cox regression analysis, variables were associated with PP-IFDs in each period were identified. Variables associated with early phase include underlying pulmonary diseases, underlying nonmalignant stable or chronic disease at allo-HSCT, unrelated or family mismatched donor, and prolonged neutropenia. Variables associated with the late phase include high ferritin level at the time point of allo-HSCT, use of secondary immunosuppressive agents due to refractory graft-versus-host disease (GVHD), and cytomegalovirus reactivation. For the very late phase, variables were secondary neutropenia, severe chronic GVHD, and use of TNF-alpha inhibitor for refractory GVHD. This study revealed the high cumulative incidence of IFDs in Korean allo-HSCT recipients, which have distinct risk factors in each phase after allo-HSCT. Our findings indicate that tailored antifungal prophylaxis is necessary for high-risk patients. Clinicians should consider using mold-active antifungal prophylaxis in allo-HSCT recipients who have high risks at different treatment period.

Original languageEnglish
Pages (from-to)1773-1779
Number of pages7
JournalBiology of Blood and Marrow Transplantation
Issue number10
Publication statusPublished - 2017 Oct
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2017 The American Society for Blood and Marrow Transplantation


  • Epidemiology
  • Hematopoietic stem cell transplantation
  • Mycoses
  • Republic of Korea
  • Risk factors

ASJC Scopus subject areas

  • Hematology
  • Transplantation


Dive into the research topics of 'Epidemiology and Risk Factors for Invasive Fungal Diseases among Allogeneic Hematopoietic Stem Cell Transplant Recipients in Korea: Results of “RISK” Study'. Together they form a unique fingerprint.

Cite this