Background Patients with a history of invasive aspergillosis (IA) prior to transplant may be at high risk for IA recurrence and transplant-related mortality (TRM) after hematopoietic stem cell transplantation (HCT). This study was performed to determine outcomes and to identify risk factors for recurrent IA and TRM in allogeneic HCT patients with a history of prior IA. Methods Between 12/1992 and 5/2001, we performed prospective monitoring to identify patients with a history of IA prior to first allogeneic HCT at FHCRC. Patients with IA that was defined as possible, probable, or proven according to established EORTC/NIH-MSG criteria were included. Practice was to treat patients with IA for at least one month prior to HCT; stabilization of radiographic signs was required to proceed with transplant. Post-transplant outcomes (IA and TRM) were determined by chart review and compared to contemporaneous controls. Log-rank tests were used to compare the probabilities of IA after transplant over time across patient subgroups. Results Among 2319 patients who underwent first allogeneic HCT, 44 patients (1.9%; 36 myeloablative, 8 nonmyeloablative) were known to have prior IA (34 proven, 2 probable, 8 possible). Median time from diagnosis of IA to transplant was 100 days (range; 7-2422). Thirteen patients (30%) were diagnosed with IA at a median of 27 days (range; 1-242) after transplant. Receipt of antifungal therapy for 30 days) and more aggressive antifungal therapy prior to HCT, with resolution of radiographic abnormalities, and, possibly, HCT with nonmyeloablative or non-TBI-containing myeloablative conditioning regimens.
Full conference title:
Amerian Society of Hematology Annual Meeting
- ASH 44th (2002)