Invasive aspergillosis in adult haematopoietic stem cell transplant recipients

Ref ID: 18553

Author:

M. Popova (1), V. Vavilov (1), A. Volkova (1), I. Zyuzgin (2),
Y. Borzova (3), S. Hostelidy (3), S. Ignatyeva (3), T. Bogomolova
(3), L. Zubarovskaya (1), N. Klimko (3), B. Afanasyev (1)

Author address:

(1)I.P. Pavlov State Medical University (St. Petersburg, RU);
(2)Leningrad Regional Clinical Hospital (St. Petersburg,
RU); (3)I. Mechnikov Nord-West State Medical University
(St. Petersburg, RU)

Full conference title:

Annual Meeting of the EBMT, 38th

Abstract:

Background: Invasive aspergillosis (IA) is major cause of morbidity and mortality in hematopoietic stem cell transplant (HSCT)
recipients. This study focuses on the risk factors, etiology and
outcomes of IA.
Methods: 356 pts after allogenic (allo) (237) and autologous
(auto) HSCT (119) were included in 2000-2010 yy. Baseline
patient characteristics and abbreviations are outlined in Table 1.
EORTC/MSG 2008 diagnostic criteria of IFD (proven and probable) were used.
Results: The incidence of IA in alloHSCT group was higher
19% (45/237) then in autoHSCT group 9,2% (11/119)
(p<0,001). Etiologic agents of IA after alloHSCT were A. fumigatus 60%, A. niger 20%, A. fl avus, A. ochracea, A. terreus - 9%, and unidentifi ed Aspergillus spp. 11%. IA after autoHSCT were caused by A. fumigatus 54,5%, A. niger 18,2%, A. fl avus 9,1%, unidentifi ed Aspergillus spp. 18,2%. Median date of IA onset after alloHSCT was D+34 (3-610), after autoHSCT - D+11 (6-38) (p<0,05). In alloHSCT group risk factors were: previous IFD, nonmyeloablative (RIC) regimen, fl udarabin and anti-thymocyte globulin (ATG) use in conditioning regimen, lymphopenia >3 weeks, grade 4 neutropenia >2 weeks, acute GVHD,
severe bacterial infection, CMV infection, underlying AL,
and PBSC as a source of HSC (p<0,05). In this group cyclosporine A use was associated with higher risk of IA than tacrolimus (p<0,05). In autoHSCT group risk factors were: previous IFD, mucositis grade III-IV, lymphopenia >3 weeks, grade 4 neutropenia
>2 weeks, severe bacterial infection (p<0,05). In this group G-CSF use was associated with increased risk of IA (p<0,001). In HSCT recipients the 12-week OS rate after diagnosis of IA was 68,2%. In 2000-2005 yy. 12-week OS rate was 52,6%, in 2006-2010 yy. - 72,7% (p<0,05) due to routine diagnostic procedures (galactomannan (GM) test and CT scan) and new antifungal drugs use. Conclusion: The incidence of IA in HSCT recipients was 16% (allo - 19%, auto - 9%). We reveal high rate of Aspergillus non-fumigatus as etiological agents. Usage of new antifungal drugs, routine GM test and CT scan improved 12-week OS rate.

Abstract Number: P480

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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