title: Outcome analysis of invasive aspergillosis in hematologic malignancy and hematopoietic stem cell transplant patients: the role of novel antimold azoles.
abstract: BACKGROUND
  Invasive aspergillosis (IA) continues to be a leading cause of morbidity and mortality in hematologic malignancy (HM) patients. We evaluated the prognostic factors for IA in HM patients.
  
  
  METHODS
  In this retrospective study, we included all HM patients diagnosed with proven or probable IA between June 1993 and June 2008.
  
  
  RESULTS
  A total of 449 HM patients were analyzed, the majority of which (75%) had underlying leukemia. Multivariate logistic regression analysis showed that neutropenia for more than two weeks during IA, steroid use, and intensive care admission were independently associated with failure to respond to antifungal therapy, as well as increased IA-attributable mortality (all p-values < .01). Antifungal therapy with an antimold azole-containing regimen (voriconazole or posaconazole) was also independently associated with improved response to treatment, as well as decreased IA-attributable mortality (all p-values < .0001). Survival analysis showed that primary or salvage therapy with a regimen that contained antimold azoles was significantly associated with improved survival (p < .001).
  
  
  CONCLUSIONS
  In HM patients, persistent neutropenia and the need for intensive care are associated with failure to respond to antifungal therapy. Use of novel antimold azoles, either as primary or salvage therapy, improves the overall outcome and IA-attributable death of HM patients with IA.
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Ramos
authors.forename: Ying
authors.initials: Y
authors.lastname: Jiang
authors.forename: Ray
authors.initials: R
authors.lastname: Hachem
authors.forename: Christelle
authors.initials: C
authors.lastname: Kassis
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
authors.forename: Issam
authors.initials: I
authors.lastname: Raad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy* / Q000209:etiology* / Q000382:microbiology; D001393:Azoles / Q000627:therapeutic use*; D002648:Child; D019337:Hematologic Neoplasms / Q000382:microbiology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D001393:Azoles