Changing landscape of invasive aspergillosis in allogeneic stem cell transplant recipients.
Invasive aspergillosis (IA) is an important infectious complication in allogeneic stem cell transplant (SCT) recipients. Diagnosis of IA has been difficult and often delayed and treatment outcome has been poor, with mortality rates up to 80%. This review summarizes recent developments in this field. There are indications that the incidence of IA may be decreasing due to multiple factors including better understanding of pathogenesis of IA, earlier diagnosis, and various prophylactic and preventive strategies. Recently posaconazole has shown to be effective in reducing the risk of IA in patients treated for graft-versus-host disease (GVHD). Early use of high-resolution thoracic computed tomography assisted with complimentary methods including bronchoalveolar lavage and serum galactomannan determinations are useful in early diagnosis. Our treatment armamentarium against IA has broadened significantly during the last years and there are some indications of improved outcome more recently. On the other hand, increasing use of blood progenitor grafts instead of marrow with higher risk of chronic GVHD, increasing age of SCT recipients, and wide use of donor lymphocyte infusions for treatment of minimal residual disease or relapse may affect to the opposite direction. Despite some promises and improvements, IA will continue to remain a challenge in the upcoming years.
Jantunen
E
E
Department of Medicine, Kuopio University Hospital, Kuopio, Finland. esa.jantunen@kuh.fi
Nihtinen
A
A
Anttila
V-J
VJ
D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D005690:Galactose / Q000031:analogs & derivatives; D006086:Graft vs Host Disease / Q000150:complications; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000628:therapy; D008351:Mannans / Q000097:blood; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D000935:Antifungal Agents; D008351:Mannans; C012990:galactomannan; D005690:Galactose