Invasive aspergillosis in the hematologic and immunologic patient: new findings and key questions in leukemia


Herbrecht R, Moghaddam A, Mahmal L, Natarajan-Ame S, Fornecker LM, Letscher-Bru V
Med Mycol. 2005 May;43 Suppl 1:S239-42


Patients suffering from acute leukemia are at high risk for invasive aspergillosis anda large review and a recent clinical trial have shown that they represent the largestgroup of patients developing the disease. New host groups such as patients withmultiple myeloma or low-grade lymphoproliferative disorders have contributed toan increase in the incidence of invasive aspergillosis over recent years. There aresubstantial differences in the diagnostic strategy and therapeutic outcome ofdisease between patients with a hematological malignancy and other host groupssuch as allogeneic hematopoietic stem cell transplant patients. Galactomannandetection ELISA test is more specific in adult patients with hematologicalmalignancies than in hematopoietic stem cell transplantation recipients. As aresult of possible improvement of the underlying immune deficiency upon recoveryfrom neutropenia, survival is higher in leukemic patients with invasive aspergillosisthan in other host groups. However, there is currently no evidence of an effectiveantifungal prophylaxis strategy against aspergillosis in leukemic patients. As thesepatients account for a majority of the aspergillosis cases, clinical trials onprophylaxis should not only be focused on allogeneic stem transplant recipientsbut also be designed for the patient with leukemia.