Outcome of invasive aspergillosis after allogeneic haematopoietic stemcell transplantation in patientswith invasive aspergillosis before transplantation

M. Popova, A. Volkova, V. Vavilov, S. Bondarenko, I. Zyuzgin, O. Shadrivova, S. Khostelidi, S. Ignatyeva, T. Bogomolova,L. Zubarovskaya, B. Afanasyev, N. Klimko

Abstract: 

Invasive aspergillosis (IA) is an important cause of morbidity and mortality in hematological patients. Number of patients with IA who are
candidates for allogeneic hematopoietic stem cell transplant (alloHSCT) is increased. This study focuses on clinical characteristics, risk
factors and outcome of IA after alloHSCT in pts who had IA before transplantation.
Prospective single center study from Dec 2012 to Jul 2013. Thirty-nine pts with proven and probable IA before HSCT have included and
observed after alloHSCT. EORTC/MSG 2008 criteria for diagnosis and response to therapy were used. “Active IA” means IA diagnosed just
before HSCT. We observed 39 pts predominantly with acute leukemia (74%) after alloHSCT with proven and probable IA which have been diagnosed
before HSCT. According to EORTS/MSG 2008 criteria 92% of pts had probable and 8% proven IA. Complete response to antifungal therapy
was in 10 (26%) pts, partial response or stabilization was in 17 (43%) pts, and 12 (31%) pts with “active IA”. The main sites of infection were
lungs – 95%, central nervous system – 3%, colon – 3%, other localization was observed predominantly in combination with lung
involvement: sinuses – 5%, spleen – 3%, liver – 3%. Antifungal therapy before alloHSCT was performed in 69% pts (voriconazole – 95%,
other – 5%). During alloHSCT all pts received antifungal therapy with voriconazole (first line of therapy – 31%, continuation of treatment –
43%, and secondary prophylaxis – 26%). Median of treatment duration was 166 days (37 – 394). Cumulative incidence of relapse or
progression of IA after alloHSCT was 12,4% (n=6). Relapse of underlying disease was the main risk factor for relapse or progression of IA
after alloHSCT (6% vs 33%, p=0,007). Antifungal therapy of progression of IA after alloHSCT was voriconazole 600 mg per day (n=1) and
combination voriconazole with caspofungine (n=3). Antifungal therapy of relapse of IA after alloHSCT was voriconazole 400 mg per day
(n=2). Complete response was achieved in 4 pts, and stabilization – 2 pts. 12-weeks overall survival (OS) at after antifungal therapy start
was 67%. 100-days OS after alloHSCT was 70%, 1-year OS after alloHSCT was 57%. There was no difference in OS in pts with or without
IA before alloHSCT. There was no toxicity of antifungal treatment.
IA before HSCT isn’t a contraindication for alloHSCT. Cumulative incidence of relapse or progression of IA after alloHSCT in pts with proven
and probable IA which have been diagnosed before HSCT was 12,4%. Relapse of underlying disease was the main risk factor for relapse or
progression of IA after alloHSCT. During alloHSCT secondary prophylaxis with voriconazole should be used in pts with IA which have been
diagnosed before HSCT. Relapse or progression of IA after alloHSCT didn’t impair OS after alloHSCT.

2015

abstract No: 

P1221