Prognostic Factors for Death Due to Invasive Aspergillosis after Hematopoietic Stem Cell Transplantation: A 1-Year Retrospective Study of Consecutive Patients at French Transplantation Centers

Cordonnier, Catherine; Ribaud, Patricia; Herbrecht, Raoul; Milpied, Noël; Valteau‐Couanet, Dominique; Morgan, Caroline; Wade, Amath; Cellulaire, Société de Greffe de Moelle et de Thérapie Française

doi:10.1086/500934

Cited by 111 publications

(110 citation statements)

References 13 publications

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“…2,4,6,18 In addition, analyses of prognostic factors verify the other previously recognized important prognostic factors (uncontrolled GVHD, steroids dose). 2,4,7,19,20 There are few reports on the long-term survival (≥ one year) of allogeneic HSCT recipients with IA. The overall one-year survival rate was 20% for Seattle IA patients receiving transplants between 1993 and 1998, while survival was only 7% for the cohort receiving transplants between 1987 and 1993.…”

Section: Discussionmentioning

confidence: 99%

Persistent poor long-term prognosis of allogeneic hematopoietic stem cell transplant recipients surviving invasive aspergillosis

et al. 2012

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BackgroundVoriconazole treatment increases early survival of allogeneic hematopoietic stem cell transplant recipients with invasive aspergillosis. We investigated whether this survival advantage translates into an increased long-term survival. Design and MethodsThis retrospective study involved all patients with an invasive aspergillosis diagnosis transplanted between September 1997 and December 2008, at the Saint-Louis Hospital, Paris, France. The primary end point was survival up to 36 months. Survival analysis before and after 12 weeks, as well as cumulative incidence analysis in a competing risk framework, were used to assess the effect of voriconazole treatment and other factors on mortality. ResultsAmong 87 patients, 42 received first-line voriconazole and 45 received another antifungal agent. Median survival time was 2.6 months and survival rate at 36 months was 18%. Overall, there was a significant difference in the survival rates of the two groups. Specifically, there was a dramatic difference in survival rates up to ten months post-aspergillosis diagnosis but no significant difference after this time. Over the first 36 months as a whole, no significant difference in survival rate was observed between the two groups. First-line voriconazole significantly reduced aspergillosis-attributable mortality. However, first-line voriconazole patients experienced a significantly higher probability of death from a non-aspergillosis-attributable cause. ConclusionsAlthough the prognosis for invasive aspergillosis after stem cell transplantation has dramatically improved with the use of voriconazole, this major advance in care does not translate into increased long-term survival for these severely immunocompromised patients.Key words: invasive aspergillosis, hematopoietic stem cell transplantation, voriconazole, survival, infection. Haematologica 2012;97(9):1357-1363. doi:10.3324/haematol.2011 This is an open-access paper. © F e r r a t a S t o r t i F o u n d a t i o n © F e r r a t a S t o r t i F o u n d a t i o n Citation: Salmeron G, Porcher R, Bergeron A, Robin M, Peffault de Latour R, Ferry C, Rocha V, Petropoulou A, Xhaard A, Lacroix C, Sulahian A, Socié G, and Ribaud P. Persistent poor long-term prognosis of allogeneic hematopoietic stem cell transplant recipients surviving invasive aspergillosis. Persistent poor long-term prognosis of allogeneic hematopoietic stem cell transplant recipients surviving invasive aspergillosis

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Section: Discussionmentioning

confidence: 99%

Persistent poor long-term prognosis of allogeneic hematopoietic stem cell transplant recipients surviving invasive aspergillosis

et al. 2012

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“…Currently, the first peak is less significant because of the routine use of stem cells instead of bone marrow for transplantation, nonmyeloablative regimens, the use of colonystimulating factors during neutropenia and the widespread use of antifungal agents [13,26]. The second peak has become more significant, especially with the higher incidence of GVHD associated with unrelated allogeneic transplantation and treatment with intensive immunosuppressive therapy, including corticosteroids, cyclosporine A, anti-TNF agents, and other T-cell depleting strategies [13,14,17,[27][28][29].…”

Section: Risk Factorsmentioning

confidence: 99%

Pulmonary aspergillosis: a clinical review

Kousha¹,

Tadi²,

Soubani³

2011

Eur Respir Rev

599

596

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Aspergillus is a mould which may lead to a variety of infectious, allergic diseases depending on the host's immune status or pulmonary structure. Invasive pulmonary aspergillosis occurs primarily in patients with severe immunodeficiency. The significance of this infection has dramatically increased with growing numbers of patients with impaired immune state associated with the management of malignancy, organ transplantation, autoimmune and inflammatory conditions; critically ill patients and those with chronic obstructive pulmonary disease appear to be at an increased risk. The introduction of new noninvasive tests, combined with more effective and better-tolerated antifungal agents, has resulted in lower mortality rates associated with this infection. Chronic necrotising aspergillosis is a locally invasive disease described in patients with chronic lung disease or mild immunodeficiency. Aspergilloma is usually found in patients with previously formed cavities in the lung, whereas allergic bronchopulmonary aspergillosis, a hypersensitivity reaction to Aspergillus antigens, is generally seen in patients with atopy, asthma or cystic fibrosis. This review provides an update on the evolving epidemiology and risk factors of the major manifestations of Aspergillus lung disease and the clinical manifestations that should prompt the clinician to consider these conditions. Current approaches for the diagnosis and management of these syndromes are discussed.

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“…IFIs have a high attributable mortality despite appropriate antifungal treatment. [1][2][3][4] Non-myeloablative or reduced-intensity conditioning (RIC) results in less severe mucositis and a shorter period of neutropenia after HSCT. This has reduced the incidence of early bacterial infections, but some studies have shown that the incidence of IFI after RIC is the same or even higher than with myeloablative regimens.…”

Section: Introductionmentioning

confidence: 99%

Randomized PCR-based therapy and risk factors for invasive fungal infection following reduced-intensity conditioning and hematopoietic SCT

Blennow

Remberger

Klingspor

et al. 2010

Bone Marrow Transplant

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Invasive fungal infections (IFIs) are major complications after allogeneic hematopoietic SCT (HSCT). PCR-based assays able to detect fungal DNA have been reported to precede clinical diagnosis of IFI. We performed a prospective study to evaluate a PCR-based pre-emptive approach. Ninety-nine patients undergoing reduced-intensity conditioning (RIC) HSCT were followed with fungal PCR during the first 100 days post transplantation. Patients who tested positive were randomized to receive liposomal amphotericin B, or to no intervention. After day 100, PCR tests were performed only on clinical suspicion of IFI. A single positive PCR test was not associated with IFI, irrespective of treatment. After day 100, PCR tests for Aspergillus did not contribute to diagnosis of invasive aspergillosis (IA). The cumulative incidence rates of proven or probable IA during the first year after transplantation were 9%. GVHD grades II-IV (P ¼ 0.0014), CMV-seronegative recipient with CMVseropositive donor (Pp0.001), and conditioning with alemtuzumab (P ¼ 0.014) were significant risk factors for developing IA in a multivariate model. In this study, PCR on peripheral blood was a poor indicator of IFI early after RIC HSCT. Aspergillus PCR tests performed on clinical suspicion after day 100 were insufficiently sensitive to be diagnostically useful.

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Prognostic Factors for Death Due to Invasive Aspergillosis after Hematopoietic Stem Cell Transplantation: A 1-Year Retrospective Study of Consecutive Patients at French Transplantation Centers

Cited by 111 publications

References 13 publications

Persistent poor long-term prognosis of allogeneic hematopoietic stem cell transplant recipients surviving invasive aspergillosis

Persistent poor long-term prognosis of allogeneic hematopoietic stem cell transplant recipients surviving invasive aspergillosis

Pulmonary aspergillosis: a clinical review

Randomized PCR-based therapy and risk factors for invasive fungal infection following reduced-intensity conditioning and hematopoietic SCT

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