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Invasive aspergillosis in acute myeloid leukaemia: report of Seifem-2008 multi-centre survey

Abstract number: O241

Caira M., Candoni A., Picardi M., Offidani M., Specchia G., Stanzani M., Cattaneo C., Fanci R., Caramatti C., Rossini F., Potenza L., Ferrara F., Mitra M.E., Invernizzi R., Aloisi T., Martino B., Bonini A., Lanasa G., Chierichini A., Melillo L., de Waure C., Fianchi L., Riva M., Aversa F., Leone G., Nosari A., Pagano L.

Objectives: To evaluate epidemiological characteristics and outcome of invasive aspergillosis (IA) in acute myeloid leukaemia patients (AMLs) and to analyse efficacy of different therapeutic approaches.

Methods: A survey was conducted over 2004–2007 in 21 Italian Haematology Divisions. All proven/probable IA were reported. AMLs submitted to transplant were excluded. The parameters we analyzed were: age, sex, AML phase, site of IA, severity, duration and recovery from neutropenia, antifungal prophylaxis, empirical/pre-emptive therapy, 1st/2nd line target therapy, aetiologic agent, G-CSF use, neutrophil transfusion, outcome. We also collected date of symptoms onset, diagnosis, antifungal therapy start and exitus. All variables were investigated as predictors of death. Follow up was assessed at 90th day from diagnosis.

Results: 140 cases were collected. Infection mostly occurs after the 1st course of chemotherapy (61%). The majority of AMLs experienced a deep neutropenia before symptoms onset (90%). Probable IA were 66%. As expected, pulmonary localisation was predominant (126/140, 90%). Infection disseminated in 5 pts. Aspergillus subtype was known in 55 pts only. Overall attributable mortality rate was 27% (38/140); it remained stable over years. Outcome was significantly influenced by AML phase (p < 0.001), duration of (p = 0.05) and recovery from neutropenia (p < 0.001). Role of neutropenia duration was confirmed at multivariate analysis (p < 0.005).

Antifungal approaches are reported in table 1.

Many pts received systemic prophylaxis (72%); itraconazole and fluconazole were used in 68 and 33 pts respectively. No differences emerged between empirical vs pre-emptive therapy and none of the drugs resulted to significantly influence outcome. In 66% of pts initial empirical/pre-emptive drug remained unchanged after IA diagnosis, while in 16% clinicians shifted to a combined treatment.

Conclusion: This study allows as to analyzed multiple factors as potentially influencing outcome. We confirmed that AML phase and neutropenia influence IA outcome. Present data confirm the perception that during last years the application of a correct and timely diagnostic work-up and the availability of more efficacious and less toxic drugs (i.e. voriconazole, liposomal amphotericin B, caspofungin) have modified the course of IA. However none of the new drugs emerged as the most efficacious in our series. Even combined treatment did not confer any advantage in survival analysis.

 AMLsDeaths (AMR%)p value
Systemic prophylaxis   
  Not administered398 (20.5)0.27
  Administered10130 (30) 
Empirical/pre-emptive   
  Caspofungin289 (32) 
  L-AmB5412 (22) 
  Itraconazole52 (40)0.79
  Voriconazole256 (24) 
  Other165 (31) 
  Not done124 (33) 
First-line therapya   
  Caspofungin289 (32) 
  L-AmB379 (24)0.65
  Voriconazole387 (18) 
  Combined225 (23) 
  Other114 (36) 
a4 early deaths

Session Details

Date: 16/05/2009
Time: 00:00-00:00
Session name: 19th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Helsinki, Finland, 16 - 19 May 2009
Presentation type:
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