title: Persistent poor long-term prognosis of allogeneic hematopoietic stem cell transplant recipients surviving invasive aspergillosis.
abstract: BACKGROUND
  Voriconazole treatment increases early survival of allogeneic hematopoietic stem cell transplant recipients with invasive aspergillosis. We investigated whether this survival advantage translates into an increased long-term survival.
  
  
  METHODS
  This retrospective study involved all patients with an invasive aspergillosis diagnosis transplanted between September 1997 and December 2008, at the Saint-Louis Hospital, Paris, France. The primary end point was survival up to 36 months. Survival analysis before and after 12 weeks, as well as cumulative incidence analysis in a competing risk framework, were used to assess the effect of voriconazole treatment and other factors on mortality.
  
  
  RESULTS
  Among 87 patients, 42 received first-line voriconazole and 45 received another antifungal agent. Median survival time was 2.6 months and survival rate at 36 months was 18%. Overall, there was a significant difference in the survival rates of the two groups. Specifically, there was a dramatic difference in survival rates up to ten months post-aspergillosis diagnosis but no significant difference after this time. Over the first 36 months as a whole, no significant difference in survival rate was observed between the two groups. First-line voriconazole significantly reduced aspergillosis-attributable mortality. However, first-line voriconazole patients experienced a significantly higher probability of death from a non-aspergillosis-attributable cause.
  
  
  CONCLUSIONS
  Although the prognosis for invasive aspergillosis after stem cell transplantation has dramatically improved with the use of voriconazole, this major advance in care does not translate into increased long-term survival for these severely immunocompromised patients.
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Service d’Hématologie-Greffe, Hôpital Saint-Louis, Paris, France.
authors.forename: Géraldine
authors.initials: G
authors.lastname: Salmeron
authors.forename: Raphaël
authors.initials: R
authors.lastname: Porcher
authors.forename: Anne
authors.initials: A
authors.lastname: Bergeron
authors.forename: Marie
authors.initials: M
authors.lastname: Robin
authors.forename: Régis
authors.initials: R
authors.lastname: Peffault de Latour
authors.forename: Christèle
authors.initials: C
authors.lastname: Ferry
authors.forename: Vanderson
authors.initials: V
authors.lastname: Rocha
authors.forename: Anna
authors.initials: A
authors.lastname: Petropoulou
authors.forename: Aliénor
authors.initials: A
authors.lastname: Xhaard
authors.forename: Claire
authors.initials: C
authors.lastname: Lacroix
authors.forename: Annie
authors.initials: A
authors.lastname: Sulahian
authors.forename: Gérard
authors.initials: G
authors.lastname: Socié
authors.forename: Patricia
authors.initials: P
authors.lastname: Ribaud
mesh_terms: D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D001230:Aspergillus / Q000472:pathogenicity*; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000150:complications / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D065819:Voriconazole / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole