Risk factors for late invasive aspergillosis (IA) after allogeneic stem cell transplantation Meeting Abstract

  


Authors: Almyroudis, N.; Jaffe, D.; Sepkowitz, K. A.; Pamer, E. G.; Meier, E.; Papadopoulos, E.; Small, T. N.; Papanicolaou, G. A.
Abstract Title: Risk factors for late invasive aspergillosis (IA) after allogeneic stem cell transplantation
Meeting Title: 43rd Annual Interscience Conference on Antimicrobial Agents and Chemotherapy
Abstract: Background: Known risks for IA include neutropenia and steroid treatment. Non-myeloablative (NMA) conditioning regimens and aggressive treatment for GVHD have enhanced survival of older patients (pts) with refractory GVHD. To determine if these changes affected IA rates, we examined IA epidemiology in 353 allogeneic HSCT treated at MSKCC, 1999-2002. Methods: Case control study. Definite or probable IA defined by histopathology and microbiology records. IA was early (0-40) days, or late (>90) days post HSCT. Controls: Pts with no evidence of IA during study period. Pts with GVHD requiring steroids received mold prophylaxis with low dose ampho B or itraconazole. Results: Median age 31y, T-cell depleted 62%, Matched siblings 52%, PBSCT 35%, GVHD 30%. Hematologic malignancy-standard risk 21.5%, high risk 63%, non-malignant 13%. Ablative 84.5%, NMA: mel/flu/campath 7%. 25/353 pts (7%) had IA (definite 64%); 60% of cases were late disease. Risk for early IA: older age (p 0.06), MDS (0.006) and conditioning with mel/flu/campath (p0.05). Risk for late IA: GVHD (0.009), steroids (p<0.001) or campath (p=0.001). Donor type, stem cell source, T cell depletion or CMV recipient serology or ANC post 90d were not different in cases and controls. The survival of IA cases was significantly lower than controls (p<0.001): Survival: for early IA 28.6% at 180d, for late IA 33.4% at 365d post HSCT. Conclusions: 1) IA incidence was 7.1%, highest >90d post-HSCT (5%). 2) Risks for early IA: NMA conditioning with mel/flu/campath, increased age and diagnosis of MDS. 3) The only significant risk factor for late IA was severe GVHD on steroids or campath 4) As GVHD is managed with increasingly intense immunosuppressants, we anticipate an increase of late IA. 5) Prolonged prophylaxis for patients at risk for late IA needs to be studied.
Keywords: risk factors; patient survival
Journal Title: Abstracts of the Interscience Conference on Antimicrobial Agents and Chemotherapy
Volume: 43
Meeting Dates: 2003 Sep 14-17
Meeting Location: Chicago, IL
ISSN: 0733-6373
Publisher: American Society for Microbiology  
Date Published: 2003-09-01
Start Page: 457
Language: English
ACCESSION: BCI:BCI200300580444
PROVIDER: biosis
Notes: Meeting Abstract: M-1006 -- 43rd Annual Interscience Conference on Antimicrobial Agents and Chemotherapy -- Chicago, IL, USA -- September 14-17, 2003 -- American Society for Microbiology -- Source: Biosis