Invasive aspergillosis in patients with multiple myeloma.

O. Shadrivova1 , V. Pivovarova1 , Y. Chudinovskikh2 , T. Shneyder3 , O. Uspenskaya3 , M. Popova4 , A. Volkova4 , E. Desyatik5 , Y. Borzova5 , S. Ignatyeva5 , T. Bogomolova5 , L. Zubarovskaya4 , B. Afanasyev4 , N. Vasilyeva5 , N. Klimko1

Author address: 

1Department Of Clinical Mycology, Allergy And Immunology, North-Western State Medical University named after I.I.Mechnikov, St. Petersburg, Russian Federation, 2N.N. Petrov National Medical Research Centre of Oncology, Ministry of Health of Russian Federation, St. Petersburg, Russian Federation, 3Leningrad Regional Clinical Hospital, St. Petersburg, Russian Federation, 4 I.Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russian Federation, 5Kashkin Research Institute Of Medical Mycology, North-Western State Medical University named after I.I.Mechnikov, St. Petersburg, Russian Federation

Abstract: 

Objectives: Identification offeatures of invasiveaspergillosis (IA)in patients with multiple myeloma(MM).

Methods: Retrospective analysis of 337 adult hematological patients with IA. In the main group were included 39 patients with MM, median age – 56 years (41 - 79), females - 59%. The control groupincluded 298 hematological patients (acute leukemia – 45%, lymphoma – 36%; chronic leukemia – 13%, myelodysplastic syndrome – 5%; other – 1%), median age – 53 years (40 - 78), females – 56%. The EORTS/MSG 2008 criteria were used for IA diagnosis and assessment of response of therapy.

Results: The main risk factorsfor IA were steroid use (87.5% vs 59.5%, p = 0.03), severe neutropenia (51% vs 76%, p = 0.03; median 14 vs 18 days), lymphocytopenia (33% vs 53%, median 10 vs 12.5 days), auto-HSCT (28% vs 4%, p = 0.01), and allo-HSCT (8% vs 13%). The main sites of infection were lungs (97,4% vs 97,3%), usually bilateral (69% vs 77%). The main clinical symptoms were fever (80% vs 78%), cough (69% vs 61%),chest pain (16% vs 5%, p = 0.03), and hemoptysis (0% vs 6.4%, p = 0.001). Aspergillus spp. positive culture was received in 69% vs 46% patients. The etiology of IA in patients with MM: A. niger– 45%, A. fumigatus– 35%, A.flavus– 10%, A. candidus– 5%, A. ochraceus– 5%.Antifungal therapy (voriconazole – 68,2% vs 64%) was used in 100% MM and 98% control group patients. The overall 12-weeks survival rate was 96% vs 80%, p = 0.01.

Conclusion: The typical risk factors for invasive aspergillosis in multiple myeloma patients were steroids use (87,5%), and auto-HSCT (28%). The main sites of infection were lungs (97,4%). The main etiological agents were A. niger(45%) and A. fumigatus(35%). In multiple myelomapatients the overall 12-weeks survival rate was significantly higher compared to the control group (96%vs 80%, p = 0.01).

2019

abstract No: 

P298

Full conference title: 

9th Trends in Medical Mycology Conference 2019
    • TIMM (2019)