Invasive Aspergillosis following Hematopoietic Cell Transplantation: Outcomes and Prognostic Factors Associated with Mortality

Abstract

There has been a significant decrease in mortality in patients with a diagnosis of IA following HCT in recent years, coinciding with multiple changes in transplantation practices, including use of nonmyeloablative conditioning regimens, receipt of peripheral blood stem cells, more prompt diagnosis of IA, and use of voriconazole.

Invasive aspergillosis in patients with hematologic malignancies: incidence and description of 127 cases enrolled in a single institution prospective survey from 2004 to 2009

“…31 It has been reported that 3-month mortality decreased from 45% in 1990-2001 to 22% in 2002-2004. 9 Moreover, Pagano et al reported a 120-day overall mortality of 33% in AML patients with IA while the 3-month mortality was 38% in our cohort. 28 We observed a similar trend in a more recent period, which could be related to earlier diagnosis, more active antifungal drugs, and/or changes in hematology practices.…”

“…4,[6][7][8] IA prevention and treatment remain important issues. Recently-observed improvement in survival 9 has been related to changes in clinical practices, and despite greater risk of aplasia, the prognosis of hematologic diseases has improved in recent years with more efficient chemotherapies. 10 IA incidence varies according to underlying hematologic disease and studies reported, being between 5% and 24% in acute leukemia patients [11][12][13][14] and between 3% and 11% in allogeneic stem cell transplantation.…”

Recent decrease in non-relapse mortality due to GVHD and infection after allogeneic hematopoietic cell transplantation in non-remission acute leukemia

“…Alternatively, the unique HLA epidemiological genetics of Japanese patients may have affected the results. 33,34 As GVHD and infection have been reported to be associated with each other's development and exacerbation, [35][36][37] an improved control of severe GVHD, along with the introduction of new antifungal drugs, may have led to the reduction of the risk of infection-related mortality. We did not find a reduction in the risk of organ failure-related mortality in any of the subgroups.…”

Fungal Infections in Transplant and Oncology Patients

“…In general, IA occurs more frequently and is encountered later after allogeneic HSCT compared with autologous HSCT. Late IA has been associated with a higher mortality, possibly because of increased fungal burden accompanying a delay in diagnosis as well as the cumulative burden of immunosuppression in patients with chronic/refractory GVHD [69].…”

“…In general, IA occurs more frequently and is encountered later after allogeneic HSCT compared with autologous HSCT. Late IA has been associated with a higher mortality, possibly because of increased fungal burden accompanying a delay in diagnosis as well as the cumulative burden of immunosuppression in patients with chronic/refractory GVHD [69].The timing of non-Aspergillus mould infections such as Zygomycetes, Fusarium, and Scedosporium, appears to be organism-specific. One large study of over 5500 HSCT recipients showed that the majority (56%) of Zygomycete infections occurred greater than 90 days after transplant and GVHD was associated with Zygomycete infection.…”