Invasive aspergillosis in neutropenic patients: rapid neutrophil recovery is a risk factor for severe pulmonary complications.
BACKGROUND
In invasive aspergillosis, the duration of neutropenia is an accepted risk factor, and recovery from neutropenia is generally associated with a favourable outcome. However, the rapidity of granulocyte recovery may rarely be associated with adverse sequelae. The purpose of this study was to define the relationship between neutrophil (polymorphonuclear, PMN) recovery after chemotherapy-induced bone marrow aplasia and the occurrence of severe pulmonary complications (haemoptysis, pneumothorax and death) in patients with haematological malignancies who developed invasive fungal pneumonias.


METHODS
Twenty consecutive patients were retrospectively studied; eight of them had developed pulmonary events between 5 and 11 days after neutrophil recovery that followed deep neutropenia (PMN < 100 microL-1).


RESULTS
Five patients had haemoptysis (one of these also had pneumothorax) and three had pneumothorax. According to the multiplicative logistic model, the odds of occurrence of a pulmonary event increased significantly with increasing PMN count on the fifth day (P < 0.001). Five of the eight patients who had pulmonary complications died. Also, the risk of death was larger in the presence of rapid neutrophil recovery, although the difference was not statistically significant (P = 0.111). Analysis of clinical and laboratory data showed that the risk of pulmonary complications significantly increased when the neutrophil concentration was > 4500 microL-1 on day 5 after deep granulocyte neutropenia (PMN < 100 microL-1). There was no correlation between pulmonary complications, dosage of amphotericin B and deaths.


CONCLUSIONS
The occurrence of life-threatening complications in patients with invasive fungal pneumonia is closely related to rapid PMN recovery.
Todeschini
G
G
Department of Haematology, Verona University School of Medicine, Italy.
Murari
C
C
Bonesi
R
R
Pizzolo
G
G
Verlato
G
G
Tecchio
C
C
Meneghini
V
V
Franchini
M
M
Giuffrida
C
C
Perona
G
G
Bellavite
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications* / Q000188:drug therapy / Q000276:immunology* / Q000401:mortality; D005260:Female; D006098:Granulocytes / Q000276:immunology; D006469:Hemoptysis / Q000150:complications / Q000401:mortality; D006801:Humans; D008172:Lung Diseases, Fungal / Q000150:complications* / Q000188:drug therapy / Q000276:immunology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications* / Q000276:immunology; D009504:Neutrophils / Q000276:immunology*; D011030:Pneumothorax / Q000150:complications / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000666:Amphotericin B