Immunological features of invasive aspergillosis in hematological patients

Ref ID: 19411

Author:

O. V. Shadrivova,1 E. V. Frolova,1 L. V. Filippova,1
A. E. Uchevatkina,1 S. N. Khostelidi,1 T. S. Bogomolova,1
S. M. Ignatyeva,1 A. G. Volkova,2 M. O. Popova,2
L. S. Zubarovskaya,2 I. S. Zjuzgin,3 O. S. Ruzhinskaya,3
N. V. Vasilyeva,1 B. V. Afana

Author address:

1I. Metchnikov North-Western State Medical University, St.
Petersburg, Russian Federation; 2R. Gorbacheva Memorial
Institute of Children Hematology and Transplantation, St.
Petersburg, Russian Federation and 3Leningrad Regional Clinical
Hospital,

Full conference title:

6th Trends in Medical Mycology 2013

Date: 11 October 2014

Abstract:

Introduction Invasive aspergillosis (IA) often complicates hemato-
logic diseases. The immunological features in immunocompromised
patients are not well understood.
Objective To study immunological features in 63 hematological
patients with IA.
Materials and methods We observed two groups. Group I included
26 patients after allogeneic hematopoietic stem cells transplantation
(allo-HSCT), mean age of patients was 23 years (range 6-59), males
– 73%. Group II: 37 hematological patients after cytotoxic therapy
(CT), mean age – 44 years (range 6-65), males – 46%. In the allo-
HSCT group 100% of patients had the probable IA according to EO-
RTS/MSG, 2008 criteria, in the CT group – 97% probable and 3%
proven IA. Immunological parameters were evaluated within 2-
4 weeks after IA diagnosis.
Results In these groups, the prevailing underlying diseases were:
acute myeloid leukemia – 17% in each group, acute lymphoblastic
leukemia – 11% and 16%, respectively, chronic leukemia – 6% in
each group. Other hematological malignancies (lymphoma, myelo-
dysplastic syndrome, and aplastic anemia) were rare. Patients after
allo-HSCT have unrelated donors – 42%, HLA-matched – 31% and
HLA-mismatched donors – 27%. All patients received immunosup-
pressive therapy. Graft versus host disease (GVHD) was observed in
88% of cases. After allo-HSCT the IA was diagnosed between 18 and
270 days with the median of 33 days, after CT – between 5 and
50 days, median – 36 days.
12th weeks overall survival was 66% and 92% in the both groups,
respectively.
We identified significant immunological defects in all patients. In
both groups we found: lymphocytopenia (<1.0 9 109/L) (p = 0.014; p = 0.006), a reduction in the absolute number of T-helper CD4 + (<0.680 9 109/L) (p = 0.001; p = 0.018), and low number of lym- phocytes with activation markers - receptors for IL-2 (CD25 + ). Level of cytotoxic T-cells CD8 + was increased (>0.700 9 109/L)
compared to baseline in allo-HSCT patients (p < 0.001). Humoral immune response: the number of B-cells (CD20 + ), IgG (<7.0 g/l), and IgM (<0.4 g/l) was reduced in both groups. The decline of the killing activity of neutrophils and increased phagocytic activity was found in 62% and 70%, respectively, along with significant reduction in the production of proinflammatory cyto- kines IFN-c, TNF-a, IL-8, G-CSF, IL-10. Low production of IL-17 (p = 0.003) and IgA (p = 0.014) was found in allo-HSCT as com- pared to the patients receiving CT. Conclusion Invasive aspergillosis developed in hematological patients with decrease in the absolute number of lymphocytes sub- sets, immunoglobulin levels, imbalance neutrophil functional activ- ity, and significant inhibition of cellular immune response key cytokine production: IFN-c, TNF-a, G-CSF, IL-8. Special features of the immune response in allo-HSCT patients were low production of IL-17 and IgA as compared to the patients after cytotoxic therapy.

Abstract Number: p169

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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