Impact of prior invasive aspergillosis on outcome in patients receiving reduced-intensity conditioning allogeneic hematopoietic stem cell transplant

Abstract

Invasive aspergillosis (IA) is a major cause of morbidity in patients with hematological malignancies, and a major impediment to the success of allogeneic stem cell transplant (allo-SCT). The aim of this single-center retrospective study was to determine the impact of pre-transplant IA on the outcome of allo-SCT after reduced-intensity conditioning (RIC). Twenty-eight cases of proven or probable IA were diagnosed prior to RIC allo-SCT at the Paoli-Calmettes Institute Cancer Center between January 2000 and January 2008. These cases were identified among 360 patients undergoing allo-SCT. IA was defined according to EORTC criteria. Patients had predominantly (82%) acute myeloid leukemia, were diagnosed with IA at a median of 8 months (range, 1–16) pre-transplant, and received antifungal therapy for a median of 5 months (range, 1–13). IA therapy included: voriconazole (71%); single-agent itraconazole (14%); and a combination of agents (14%). Secondary prophylaxis against aspergillosis was maintained during conditioning and post-transplant in 89% of patients. After transplant, only three patients (11%) had reactivation of their IA and one patient developed disseminated fusariosis. The latter four patients experienced severe acute GVHD treated with high-dose corticosteroids. None of these patients died of IA. Eighteen patients (64%) are still alive, with a median follow-up of 23.5 months (range, 12.6–48.5). Overall survival at 2 years was 59% (95% CI, 43–83%). These data suggest that patients with adequately controlled IA can tolerate RIC allo-SCT without significant post-transplant complications.

Keywords:

• Infectious complications
• clinical results
• transplant toxicity

Acknowledgements

We thank the nursing staff for providing excellent care for our patients, and the physicians of the Hematology Department at the Institut Paoli-Calmettes for their important study contributions and dedicated patient care.

Declaration of interest: We would like to thank the Association pour la Recherche sur le Cancer (ARC) (Pole ARECA; ITAC protocols) for their generous support of our research. Our group is supported by several grants from the French Ministry of Health as part of the Programme Hospitalier de Recherche Clinique (PHRC).