Impact of prior invasive aspergillosis on outcome in patients receiving reduced-intensity conditioning allogeneic hematopoietic stem cell transplant.
Invasive aspergillosis (IA) is a major cause of morbidity in patients with hematological malignancies, and a major impediment to the success of allogeneic stem cell transplant (allo-SCT). The aim of this single-center retrospective study was to determine the impact of pre-transplant IA on the outcome of allo-SCT after reduced-intensity conditioning (RIC). Twenty-eight cases of proven or probable IA were diagnosed prior to RIC allo-SCT at the Paoli-Calmettes Institute Cancer Center between January 2000 and January 2008. These cases were identified among 360 patients undergoing allo-SCT. IA was defined according to EORTC criteria. Patients had predominantly (82%) acute myeloid leukemia, were diagnosed with IA at a median of 8 months (range, 1-16) pre-transplant, and received antifungal therapy for a median of 5 months (range, 1-13). IA therapy included: voriconazole (71%); single-agent itraconazole (14%); and a combination of agents (14%). Secondary prophylaxis against aspergillosis was maintained during conditioning and post-transplant in 89% of patients. After transplant, only three patients (11%) had reactivation of their IA and one patient developed disseminated fusariosis. The latter four patients experienced severe acute GVHD treated with high-dose corticosteroids. None of these patients died of IA. Eighteen patients (64%) are still alive, with a median follow-up of 23.5 months (range, 12.6-48.5). Overall survival at 2 years was 59% (95% CI, 43-83%). These data suggest that patients with adequately controlled IA can tolerate RIC allo-SCT without significant post-transplant complications.
El-Cheikh
Jean
J
Unité de Transplantation et de Thérapie Cellulaire (UTTC), Institut Paoli-Calmettes, Marseille, France. elcheikhj@marseille.fnclcc.fr
Castagna
Luca
L
Wang
Ling
L
Esterni
Benjamin
B
Faucher
Catherine
C
Fürst
Sabine
S
Pierre
Berger
B
Mohty
Mohamad
M
Blaise
Didier
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000382:microbiology* / Q000628:therapy*; D001230:Aspergillus / Q000472:pathogenicity*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000382:microbiology* / Q000401:mortality / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
D000935:Antifungal Agents