title: [Effects of surgical resection of pulmonary lesions to the relapse of pulmonary aspergillosis in allogeneic hematopoietic stem cell transplant recipients with invasive pulmonary aspergillosis].
abstract: OBJECTIVE
  To explore the rate of breakthrough invasive pulmonary aspergillosis (IPA) in patients receiving surgical resection of pulmonary aspergillosis lesions prior to allogeneic hematopoietic stem cell transplantation (allo-HSCT).
  
  
  METHODS
  A retrospective analysis was conducted between January 2007 and June 2014. A total of 16 patients were enrolled, who had persistent pulmonary lesions including cavity (diameter >2.0 cm) or mass with a history of IPA prior to allo-HSCT in Nanfang Hospital of Southern Medical University. Ten of the 16 patients underwent thoracoscopic surgery before transplantation, i. e. surgery group, the other 6 patients did not have surgery because of primary underlying diseases (non-complete remission) or multiple lesions i. e. non-surgery group. Secondary prophylactic agents were administrated based on treatment response to initial antigual therapy. The 1-year cumulative and breakthrough rate of IPA, the median time of secondary antifungal prophylaxis (SAP) and overall survival were compared between surgery and non-surgery groups.
  
  
  RESULTS
  Within a median follow-up of 364 days after transplantation (range 73 to 400 days). The success rate of SAP was 15/16. The 1-year cumulative and breakthrough IPA were 0 and 0 in surgery group, compared with 3/6 and 1/6 in non-surgery group. The median duration of SAP in surgery group and non-surgery group was 95(74-134)days and 192.5 (56-280)days respectively, which was significantly shorter in surgery group (P=0.017). The overall survival between two groups was 8/10 and 4/6 (P=0.534). No discontinuation of SAP happened in both groups due to drug-related adverse events.
  
  
  CONCLUSIONS
  In patients with persistent pulmonary IPA lesions, surgical resection followed by SAP might be effective to reduce breakthrough IPA after transplantation with short duration of prophylaxis.
authors.affiliation: Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
authors.forename: Li
authors.initials: L
authors.lastname: Gao
authors.forename: Ren
authors.initials: R
authors.lastname: Lin
authors.forename: Jing
authors.initials: J
authors.lastname: Sun
authors.forename: Zhiping
authors.initials: Z
authors.lastname: Fan
authors.forename: Qianli
authors.initials: Q
authors.lastname: Jiang
authors.forename: Fen
authors.initials: F
authors.lastname: Huang
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.forename: Hongsheng
authors.initials: H
authors.lastname: Zhou
authors.forename: Min
authors.initials: M
authors.lastname: Dai
authors.forename: Na
authors.initials: N
authors.lastname: Xu
authors.forename: Qifa
authors.initials: Q
authors.lastname: Liu
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D055744:Invasive Pulmonary Aspergillosis / Q000188:drug therapy / Q000601:surgery*; D008168:Lung / Q000473:pathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies
chemical_list: D000935:Antifungal Agents