Nosocomial invasive aspergillosis in lymphoma patients treated with bone marrow or peripheral stem cell transplants.
OBJECTIVE
To determine the prevalence of aspergillosis in lymphoma patients housed in a protective environment while undergoing a bone marrow transplant or peripheral stem cell transplant and its relation to lymphoma type, type of transplant, period of neutropenia, method of diagnosis, species of Aspergillus, and the use of empiric amphotericin B.


METHODS
Clinical, autopsy, and microbiology records were reviewed retrospectively to determine the presence or absence of invasive aspergillosis. All positive specimens underwent further review to determine parameters outlined above.


METHODS
The review took place at the University of Nebraska Medical Center with lymphoma patients housed in the oncology/hematology special care unit, which consists of 30 single-patient rooms under positive pressure with high-efficiency particulate air filtration.


METHODS
417 lymphoma patients admitted to the oncology/hematology special care unit who underwent 427 courses of high-dose chemotherapy with or without total body irradiation followed by a stem cell rescue.


RESULTS
Twenty-two cases (5.2%) of nosocomial invasive aspergillosis (14 caused by Aspergillus flavus, 2 by Aspergillus terreus, 2 by Aspergillus fumigatus, and 4 by characteristic histology) were diagnosed. The prevalence of disease according to transplant was 8.7% for allogeneic bone marrow transplant (2/23 treatments), 5.6% for autologous peripheral stem cell transplant (9/161), and 4.5% for autologous bone marrow transplant (11/243). Fifteen patients were presumptively diagnosed prior to death (68.2%) most commonly by histologic examination of skin biopsies. All 22 patients received amphotericin B therapy, 17 prior to aspergillosis diagnosis, and 7 (31.8%) survived. No patient with disseminated disease survived.


CONCLUSIONS
Even when housing lymphoma patients undergoing myeloablative therapy in a protective environment containing high-efficiency particulate air filtration, there was a risk of developing aspergillosis. These data also showed that antemortem diagnosis with aggressive amphotericin B therapy was most effective in the management of infected lymphoma patients when engraftment occurred and the disease did not become disseminated.
Iwen
P C
PC
Department of Pathology, University of Nebraska Medical Center, Omaha 68198-6495.
Reed
E C
EC
Armitage
J O
JO
Bierman
P J
PJ
Kessinger
A
A
Vose
J M
JM
Arneson
M A
MA
Winfield
B A
BA
Woods
G L
GL
D000666:Amphotericin B / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology; D001231:Aspergillus flavus; D001232:Aspergillus fumigatus; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D003428:Cross Infection / Q000453:epidemiology* / Q000276:immunology; D006689:Hodgkin Disease / Q000276:immunology / Q000601:surgery* / Q000628:therapy; D006785:Hospitals, University; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000276:immunology / Q000601:surgery* / Q000628:therapy; D009329:Nebraska / Q000453:epidemiology; D012189:Retrospective Studies; D033581:Stem Cell Transplantation
D000666:Amphotericin B