Impact of Previous Aspergillosis on the Outcome of Bone Marrow Transplantation

Abstract

A retrospective analysis of 48 patients with documented or probable invasive aspergillosis (IA) prior to bone marrow transplantation (BMT) was conducted in 16 centers. Treatment of primary IA was medical in all 48 patients and surgical in 20; clinicoradiological resolution of IA occurred in 30 of 48 patients. Pretransplantation risk factors for relapse IA, total mortality, and IA-related mortality were analyzed by multivariate logistic regression with the following dichotomous risk factors: surgery as part of the initial treatment, resolution of IA by the time of BMT, donor type, conditioning regiment, total-body irradiation, T cell depletion, immunosuppressive therapy, type of antifungal prophylaxis, and growth factor prophylaxis. Conditioning with busulfan/cyclophosphamide was associated with a beneficial outcome for total survival and reduced IA-related mortality. Posttransplantation risk factors such as the development of graft-vs.-host disease (GVHD), therapy for GVHD, and the duration of neutropenia did not have a significant effect on relapse IA, IA-related mortality, or total mortality. The overall incidence of relapse IA was lower than expected (33% [16 of 48 patients]), but the mortality rate among relapsed patients was 88% (14 of 16). Patients receiving prophylaxis with absorbable or intravenous antifungals had less relapses of IA than did those not receiving prophylaxis (12 of 41 vs. four of seven, respectively). This finding reflects the need for better prophylaxis and new antifungal treatments for patients undergoing BMT who have a history of IA.

Efficacy of caspofungin and itraconazole as secondary antifungal prophylaxis: analysis of data from a multinational case registry

“…The 32% breakthrough rate despite secondary prophylaxis in our study was in line with the rate observed in other series [10,11]. Overall mortality was 16%, with one-quarter of deaths being attributed to breakthrough IFD.…”

“…However, these patients are at high risk of recurrent IFD, often with fatal outcome. The reported incidence rates of recurrent IFD range from 16% to 33% [9][10][11], and IFD-related mortality may be as high as 88% [10,12,13].…”

“…Two retrospective studies M a n u s c r i p t 7 demonstrated an ca. 30% incidence of recurrent IFD in patients undergoing allogeneic SCT after a previous episode of IFD, despite secondary antifungal prophylaxis with AMB, ITC and/or FLC [10,11].…”

Hematopoietic SCT in patients with a history of invasive fungal infection

“…Our study showed a relatively low rate of IFI-related mortality in comparison with earlier studies. [4][5][6][7][8][9] This should be dedicated to the high active secondary prophylaxis, for most of our patients (95.9%, 47/49) received broad-spectrum antifungal agents. [7][8][9] The low proportion (10.2%, 5/49) of proven cases of historical IFI may explain the difference between our results and the literature, which reflects the higher severity of infection in Days after transplantation Figure 1 Cumulative incidence of failure of prophylaxis in patients with versus without residual diseases before transplantation.…”

“…The possibility of post-transplant relapse of earlier IFI is extremely high and it is associated with a very dismal outcome. [4][5][6] Information about the feasibility of HSCT in patients with a history of IFI is limited. Few studies have focused on the secondary prophylaxis of IFI during HSCT and information about efficacy is limited.…”