272. Invasive Pulmonary Aspergillosis: Comparative Analysis in cancer patients with Underlying Hematologic Malignancy vs. Solid Tumor

Abstract

BackgroundOver the years, the profile of patients with invasive pulmonary aspergillosis (IPA) has extended beyond the commonly associated population with hematologic malignancy (HM) and is now comprising patients with solid tumors and patients with lung diseases. We therefore aimed to compare the clinical characteristics, diagnostic approach and therapeutic outcome of IPA in cancer patients with hematologic malignancies vs. solid tumor (ST).MethodsWe conducted a retrospective study evaluating consecutive cases of proven and probable IPA from March 2004 to December 2016 in a tertiary cancer center. We included patients >18 years with an underlying ST, HM, or Hematopoietic Cell Transplantation (HCT) within 1 year of IPA diagnosis.ResultsA total of 311 patients were analyzed: 225 had HM including HCT and 86 ST. Patients with ST were more likely to have had COPD (33% vs. 8%, P > 0.01) or other underlying pulmonary diseases when compared with HM patients (76% vs. 43%, P < 0.01). Radiation therapy prior to the infection was also notably higher in the ST group than the HM group (48% vs. 14%, P < 0.01). Patients with HM were more likely to have received steroid (38% vs. 15%, P = 0.0001) and have concurrent neutropenia 37% vs. 2%, P < 0.0001). A. fumigatus was most commonly recovered in patients with ST than in patients with HM (66% vs. 38%, P < 0.01). Monotherapy and voriconazole-based primary antifungal therapy were more often prescribed in patients with ST than in patients with HM (87% vs. 56%, P < 0.0001 and 77% vs. 53%, P = 0.0002 respectively). Complete or partial successful response to therapy was recorded in 66% of patients with ST compared with 40% in the HM group (P = 0.0001). IPA attributable mortality within 12 weeks was significantly higher in the HM than in the ST group (30% vs. 18%, P = 0.04).ConclusionMonotherapy with voriconazole were more often prescribed in patients with ST than in patients with HM. Patients with ST had a better response to antifungal therapy and a lower IPA attributable mortality within 12 weeks compared with those with HM.Disclosures All authors: No reported disclosures.