mpacts of diagnostic and therapeutic advances on a clinical outcome of invasive aspergillosis in haematopoietic stem cell transplantation recipients

Ref ID: 18580

Author:

Y. Asano-Mori (1), Y. Kanda (2), K. Kandabashi (3), Y. Nanya
(4), G. Yamamoto (4), S. Seo (4), M. Ichikawa (4), T. Saito (4),
K. Kumano (3), A. Hangaishi (4), Y. Imai (4), T. Takahashi (4),
M. Kurokawa (4)

Author address:

(1)Toranomon Hospital (Tokyo, JP); (2) Saitama Medical
Center, Jichi Medical University (Saitama, JP); (3)University of
Tokyo Hospital (Tokyo, JP); (4)University of Tokyo (Tokyo, JP)

Full conference title:

Annual Meeting of the EBMT, 36th

Abstract:

Objectives: Invasive aspergillosis (IA) remains one of the leading causes of morbidity and mortality after hematopoietic stem
cell transplantation (HSCT). Although the diagnostics modalities including CT scan and laboratory adjunct markers, and
the therapeutic strategies with newer mold-active agents have
been developed, the real impact of these developments on a
prognosis of IA in allogeneic HSCT recipients is still unclear.
Patients and methods: To reveal the alterations in the clinical
characteristics and outcome of IA over time, we retrospectively
analyzed the records of 221 adult patients who underwent allogeneic HSCT for the fi rst time from February, 2000 to March,
2008 at University of Tokyo Hospital.
Results: Thirty-fi ve patients had proven (n = 9) or probable
(n = 26) IA according to the EORTC 2002 criteria at a median
of 178 days (range 21-1526 days) after HSCT, with a cumulative incidence of 17.3%. The development of IA was associated
with neutropenia at an early period after HSCT in 4 patients,
and the immunosuppressive therapy for graft-versus-host
disease in 26. Thirty-three patients (94.3%) had pulmonary
disease including 2 with dissemination and 1 with tracheobronchitis, and the remaining one each showed sinusitis and gastrointestinal involvement, respectively. Among 29 patients who
underwent chest CT scan, the diameter of nodules or infi ltrates
was within 1.5 cm in 17 patients, between 1.5 to 3 cm in 6 and
larger than 3 cm in 6, which had no tendency to become smaller
across the years. Thirty patients showed positive galactomannan (GM) antigenemia defi ned as two consecutive results with
O.D.I above 0.6, which occurred at a median of 14 days prior
to diagnosis in 17 and served as the initial trigger for further
examinations instead of clinical symptoms or CT fi ndings in 11.
IA was the principal cause of death in 7 patients. A trend for the
declined IA-related mortality was observed after the approval
of micafungin in December 2002 (9.4% vs. 38.5%, P = 0.073).
Only one patient died of IA after the approval of voriconazole in
June 2005, whose diagnosis was delayed due to the coexisting
bronchiolitis obliterans organizing pneumonia. The attributable
mortality tended to be lower in patients with CT lesions within
1.5 cm than with larger lesions (6.3% vs. 33.3%, P = 0.086).
Conclusion: IA-related mortality tends to decline mainly due to
the improved therapeutic approaches. GM screening appears
to contribute signifi cantly to the earlier detection of IA.

Abstract Number: P740

Conference Year: 2010

Link to conference website: NULL

New link: NULL

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