title: Retrospective assessment of secondary prophylaxis for invasive aspergillosis in neutropenic hematology patients and identification of risk factors for relapse of fungal disease.
abstract: BACKGROUND
  Invasive aspergillosis (IA) is a critical complication in neutropenic patients. Recurrent IA is especially associated with high mortality. Therefore, secondary prophylaxis is important in patients with a history of IA. We retrospectively assessed the effect of secondary prophylaxis for IA.
  
  
  METHODS
  We reviewed the medical records of 46 hematology patients who developed possible, probable, or proven IA according to the EORTC/MSG criteria between 2005 and 2009, and who subsequently underwent chemotherapy (n = 30) or stem cell transplantation (n = 16).
  
  
  RESULTS
  Ten patients developed recurrent IA within 10 days after recovery from neutropenia. None of the 15 patients who achieved complete response (CR) of IA experienced recurrent IA. Among patients who did not achieve CR of IA, multivariate analysis identified the following independent risk factors: female sex (hazard ratio (HR) 7.23, 95% confidence interval (CI) 2.38-21.9, p = 0.00047), high serum C-reactive protein level (≥ 1 mg/dl) at the beginning of subsequent therapy (HR 4.46, 95% CI 1.51-13.2, p = 0.007), and the use of micafungin (HR 12.0, 95% CI 2.03-71.2, p = 0.0061) or amphotericin B (HR 16.5, 95% CI 1.56-174, p = 0.020) for secondary prophylaxis (reference: voriconazole).
  
  
  CONCLUSIONS
  Three risk factors for recurrent IA were identified. However, a prospective controlled trial is required to evaluate the impact of secondary prophylactic regimens.
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: Misato
authors.initials: M
authors.lastname: Kikuchi
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakasone
authors.forename: Kinuko
authors.initials: K
authors.lastname: Mitani
authors.forename: Moritaka
authors.initials: M
authors.lastname: Gotoh
authors.forename: Ayako
authors.initials: A
authors.lastname: Kobayashi
authors.forename: Naoki
authors.initials: N
authors.lastname: Kurita
authors.forename: Takeshi
authors.initials: T
authors.lastname: Saito
authors.forename: Ken
authors.initials: K
authors.lastname: Sato
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D018890:Chemoprevention / Q000379:methods*; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000453:epidemiology* / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000150:complications*; D012307:Risk Factors; D055502:Secondary Prevention; D055815:Young Adult
chemical_list: D000935:Antifungal Agents