Invasive aspergillosis increase the risk of death in acute myeloid leukaemia patients

Ref ID: 18597

Author:

M. Michallet, S. Kraghel, T. Benet, M. Sobh, M. El Hamri,
G. Cannas, F. Nicolini, E. Nicolas-Virelizier, H. Labussiere,
S. Ducastelle, R. Crocchiolo, F. Barraco, X. Thomas,
Y. Chelghoum, M. Nicolle, A. Bienvenu, F. Persat, F. De
Monbrison, N

Author address:

Hôpital Edouard Herriot (Lyon, FR)

Full conference title:

Annual Meeting of the EBMT, 36th

Abstract:

Objectives: To study the impact of invasive aspergillosis (IA)
incidence during induction therapy for acute myeloid leukemia
(AML) patients on short and long term overall survival.
Methods: A retrospective cohort study was performed in the
Hematology department of the Edouard Herriot Hospital,
Lyon (France). Patients with newly diagnosed AML between S392
01/01/2004 and 31/12/2007 were retrospectively included and
the follow-up was censored at 30/06/2009. Data were extracted
from medical charts and from the prospective surveillance of
IA (EORTC diagnosis criteria). The patients with IA after post
induction evaluation were excluded (N = 5). A Cox proportional
hazard model with diagnosis of IA and post induction evaluation
(complete remission [CR] of AML or failure of chemotherapy) as
the main exposure besides age, year of inclusion, WHO status,
cytogenetic group, kind of induction chemotherapy, and hematopoietic stem cell transplantation, was fi tted.
Results: Overall, 262 patients counting for 149 370 patientdays were analysed, the median age at diagnosis was 56.6
years (47.9-64.2 years), and 196 (75%) had CR. There were
58 (22%) IA cases with a median interval between induction
and IA of 30 days (range, 16-27 days); 29 (50%) IA were possible, 24 (41%) probable, and 5 (9%) proven. At the last followup, 165 (63%) patients died with a median overall survival of
18 months (95% confi dence interval [95% CI] 14-23 months). The
4 year-survival of patients having had IA was 14%, and without
IA 32% (P = 0.01). The 2 year-survival of patients achieving of
CR was 54% vs. 5% for patients with failure of chemotherapy
was 5% (P < 0.001). Cox multivariate analysis showed that patients in CR with IA presented a higher risk of death compared to patients in CR without IA (Hazard ratio = 1.66, 95% CI 1.05-2.65, P = 0.031). In addition, IA was associated with a higher risk of death in patients with failure of chemotherapy compared to patients in CR without IA (Hazard ratio = 6.43, 95% CI 3.72-11.10, P < 0.001) (Figure). The WHO status, cytogenetic group and kind of induction chemotherapy were associated with lower survival. Conclusion: IA was associated with a high risk of death in AML patients whether they were in CR or failure after induction chemotherapy. Cytogenetic group or WHO status are not modi- fi able risk factors for death in this population while prevention of IA with environmental procedures or using individual prophylaxis will improve survival outcome.

Abstract Number: R1268

Conference Year: 2010

Link to conference website: NULL

New link: NULL

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