The D-index is not correlated with invasive fungal infection during the early-post engraftment phase among allogeneic hematopoietic stem cell transplant recipients

  • Cybele Lara R. AbadEmail author
  • Brian Lahr
  • John C. O’Horo
  • Prakhar Vijayvargiya
  • Randall C. Walker
  • William J. Hogan
  • Aaron J. TandeEmail author
Original Article


The D-index assesses neutropenia dynamics. Prolonged neutropenia is a major risk for invasive fungal infection (IFI); we hypothesized that D-index is predictive of IFI risk. We retrospectively reviewed 789 adults who underwent allogeneic hematopoietic transplant (HSCT) from 1/1/2005 to 9/30/2015. Medical records were reviewed from transplant (D0) through Day 100. The D-index was calculated as area over the neutrophil curve until engraftment. 714 patients were included for analysis. Sixteen (2%) developed probable (11) or proven (5) IFI. Median time to IFI was 40 days (range 8–98) after HSCT. Groups with and without IFI did not differ significantly in duration of mild or profound neutropenia. Median D-index of those with IFI was 4293 days neutrophil/µl compared to 3590 days neutrophil/µl for those without IFI (P = 0.17). Patients who were neutropenic on D0 showed higher rates of IFI than those who were not (10/123 [8%] vs 6/591 [1%]; P < 0.001). Only 2% developed IFI, likely due to mold-active antifungal prophylaxis. The D-index was not significantly higher in those with IFI. Duration of profound neutropenia and neutropenia at D0 may be better markers for IFI among HSCT recipients during the first 30 and 100 days after transplant.


Invasive fungal infection D-index Hematopoietic transplant 



This work was supported by the Mayo Clinic Small Grants Award [FP85701].

Compliance with ethical standards

Conflict of interest

The authors report no conflict of interest.


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Copyright information

© Japanese Society of Hematology 2019

Authors and Affiliations

  1. 1.Department of Medicine, Section of Infectious DiseasesUniversity of the Philippines Manila, University of the Philippines-Philippine General HospitalManilaPhilippines
  2. 2.Division of Biomedical Statistics and InformaticsMayo ClinicRochesterUSA
  3. 3.Division of Infectious Diseases, Department of MedicineMayo ClinicRochesterUSA
  4. 4.Division of HematologyMayo ClinicRochesterUSA

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