Invasive aspergillosis in patients with acute myeloid leukemia: a SEIFEM-2008 registry study.
BACKGROUND
The aim of this study was to evaluate prognostic factors, treatments and outcome of invasive aspergillosis in patients with acute myeloid leukemia based on data collected in a registry.


METHODS
The registry, which was activated in 2004 and closed in 2007, collected data on patients with acute myeloid leukemia, admitted to 21 hematologic divisions in tertiary care centers or university hospitals in Italy, who developed proven or probable invasive aspergillosis.


RESULTS
One hundred and forty cases of invasive aspergillosis were collected, with most cases occurring during the period of post-induction aplasia, the highest risk phase in acute myeloid leukemia. The mortality rate attributable to invasive aspergillosis was 27%, confirming previous reports of a downward trend in this rate. Univariate and multivariate analyses revealed that the stage of acute myeloid leukemia and the duration of, and recovery from, neutropenia were independent prognostic factors. We analyzed outcomes after treatment with the three most frequently used drugs (liposomal amphotericin B, caspofungin, voriconazole). No differences emerged in survival at day 120 or in the overall response rate which was 71%, ranging from 61% with caspofungin to 84% with voriconazole.


CONCLUSIONS
Our series confirms the downward trend in mortality rates reported in previous series, with all new drugs providing similar survival and response rates. Recovery from neutropenia and disease stage are crucial prognostic factors. Efficacious antifungal drugs bridge the period of maximum risk due to poor hematologic and immunological reconstitution.
Pagano
Livio
L
M.D. Istituto di Ematologia, Università Cattolica del Sacro Cuore, Largo Francesco Vito, 1 I-00168 Roma, Italia. lpagano@rm.unicatt.it
Caira
Morena
M
Candoni
Anna
A
Offidani
Massimo
M
Martino
Bruno
B
Specchia
Giorgina
G
Pastore
Domenico
D
Stanzani
Marta
M
Cattaneo
Chiara
C
Fanci
Rosa
R
Caramatti
Cecilia
C
Rossini
Fausto
F
Luppi
Mario
M
Potenza
Leonardo
L
Ferrara
Felicetto
F
Mitra
Maria Enza
ME
Fadda
Rafaela Maria
RM
Invernizzi
Rosangela
R
Aloisi
Teresa
T
Picardi
Marco
M
Bonini
Alessandro
A
Vacca
Adriana
A
Chierichini
Anna
A
Melillo
Lorella
L
de Waure
Chiara
C
Fianchi
Luana
L
Riva
Marta
M
Leone
Giuseppe
G
Aversa
Franco
F
Nosari
Annamaria
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D001230:Aspergillus / Q000502:physiology; D000077336:Caspofungin; D054714:Echinocandins / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D055666:Lipopeptides; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011743:Pyrimidines / Q000627:therapeutic use; D012042:Registries; D015996:Survival Rate; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole; D055815:Young Adult
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D011743:Pyrimidines; D014230:Triazoles; C068538:liposomal amphotericin B; D000666:Amphotericin B; D000077336:Caspofungin; D065819:Voriconazole