Autologous bone marrow transplantation is feasible in patients with a prior history of invasive pulmonary aspergillosis.
We report on seven adult leukemic patients who were autografted in spite of a prior history of invasive pulmonary aspergillosis (IPA). Their median age was 41 years (range: 19-61); six patients were male and one female. All seven had acute myeloblastic leukemia (AML) and underwent an autologous marrow transplantation (ABMT) with a marrow purged in vitro by mafosfamide. IPA was suspected prior to ABMT on clinical and radiological features. CT scan confirmed nodular infiltrates and cavitations in six cases. Microbiological documentation consisted of: identification of the fungus from bronchoalveolar lavage: one case, positive antigenemia: one case, positive antibodies: two cases. Prior ABMT patients received amphotericin B for a median total dose of 1915 mg (range: 970-3300). No patient underwent surgery. The median time from diagnosis of IPA to ABMT was 7.3 months (range: 3-10). During ABMT all patients received prophylactic amphotericin B and itraconazole. No patient died from toxicity and no IPA reactivation was observed in any patients. Post-graft, itraconazole was kept on for a median of 3 months (range: 3-5). This study demonstrates that IPA occurring during the management of AML patients is not necessarily a contraindication to subsequent ABMT.
Michailov
G
G
Department of Hematology, Hôpital Saint-Antoine, Paris, France.
Laporte
J P
JP
Lesage
S
S
Fouillard
L
L
Isnard
F
F
Noel-Walter
M P
MP
Jouet
J P
JP
Najman
A
A
Gorin
N C
NC
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology; D016465:Bone Marrow Purging; D016026:Bone Marrow Transplantation; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D002423:Cause of Death; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000031:analogs & derivatives; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D007951:Leukemia, Myeloid / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D008172:Lung Diseases, Fungal / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D011292:Premedication; D014057:Tomography, X-Ray Computed; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous
D000935:Antifungal Agents; D017964:Itraconazole; C048341:mafosfamide; D000666:Amphotericin B; D003520:Cyclophosphamide