Influence of invasive aspergillosis during acute leukaemia treatment on survival after allogeneic stem cell transplantation: a prospective study of the EBMT Infectious Diseases Working Party

被引：3

作者：

Penack, Olaf ^{[1
,45
,46
]}

Tridello, Gloria ^{[2
]}

Salmenniemi, Urpu ^{[3
]}

Martino, Rodrigo ^{[4
]}

Khanna, Nina ^{[5
]}

Perruccio, Katia ^{[6
]}

Fagioli, Franca ^{[7
]}

Richert-Przygonska, Monika ^{[8
]}

Labussiere-Wallet, Helene ^{[9
]}

Maertens, Johan ^{[10
]}

Jubert, Charlotte ^{[11
]}

Aljurf, Mahmoud ^{[12
]}

Pichler, Herbert ^{[13
]}

Krivan, Gergely ^{[14
]}

Kunadt, Desiree ^{[15
]}

Popova, Marina ^{[16
]}

Gabriel, Melissa ^{[17
]}

Calore, Elisabetta ^{[18
]}

Blau, Igor Wolfgang ^{[1
]}

Benedetti, Fabio ^{[19
]}

Itala-Remes, Maija ^{[20
]}

de Kort, Elizabeth ^{[21
]}

Russo, Domenico ^{[22
]}

Faraci, Maura ^{[23
]}

Menard, Anne-Lise ^{[24
]}

von dem Borne, Peter ^{[25
]}

Poire, Xavier ^{[26
]}

Yesilipek, Akif ^{[27
]}

Gozdzik, Jolanta ^{[28
]}

Yegin, Zeynep Arzu ^{[29
]}

Yanez, Lucrecia ^{[30
]}

Facchini, Luca ^{[31
]}

Van Gorkom, Gwendolyn ^{[32
]}

Thurner, Lorenz ^{[33
]}

Kocak, Ulker ^{[34
]}

Sampol, Antonia ^{[35
]}

Zuckerman, Tsila ^{[36
]}

Bierings, Marc ^{[37
]}

Mielke, Stephan ^{[38
]}

Ciceri, Fabio ^{[39
]}

Wendel, Lotus ^{[2
]}

Knelange, Nina ^{[2
]}

Mikulska, Malgorzata ^{[40
,41
]}

Averbuch, Dina ^{[42
]}

Styczynski, Jan ^{[8
]}

de la Camara, Rafael ^{[43
]}

Cesaroaq, Simone ^{[44
]}

机构：

[1] Med Klin m S Hamatol Onkol & Tumorimmunol, Berlin, Germany

[2] EBMT Leiden Study Unit, Leiden, Netherlands

[3] HUCH Comprehens Canc Ctr, Helsinki, Finland

[4] Hosp Sant Creu i Sant Pau, Barcelona, Spain

[5] Univ Basel Hosp, Div Infect Dis, Basel, Switzerland

[6] Santa Maria Della Misericordia Hosp, Pediat Oncol Hematol & Stem Cell Transplantat Prog, Perugia, Italy

[7] Osped Infantile Regina Margher, Turin, Italy

[8] Nicolaus Copernicus Univ Torun, Jurasz Univ Hosp, Dept Pediat Hematol & Oncol, Coll Medicum, Bydgoszcz, Poland

[9] Hosp Civils Lyon, Hop Lyon Sud, Pierre Benite, France

[10] Univ Hosp Gasthuisberg, Leuven, Belgium

[11] CHU Bordeaux Grp Hosp Pellegrin Enfants, Bordeaux, France

[12] King Faisal Specialist Hosp & Res Ctr, Riyadh, Saudi Arabia

[13] Med Univ Vienna, St Anna Childrens Hosp, Dept Pediat & Adolescent Med, Vienna, Austria

[14] Cent Hosp Southern Pest, Budapest, Hungary

[15] Tech Univ Dresden, Univ Hosp, Dresden, Germany

[16] Pavlov Univ, RM Gorbacheva Res Inst, St Petersburg, Russia

[17] Childrens Hosp Westmead, Canc Ctr Children, Sydney, Australia

[18] Univ Padua, Azienda Osped, Dept Womens & Childrens Hlth, Pediat Hematol Oncol & Stem Cell Transplant Div, Padua, Italy

[19] Policlin GB Rossi, Verona, Italy

[20] Turku Univ Hosp, Turku, Finland

[21] Radboud Univ Nijmegen, Med Ctr, Nijmegen, Netherlands

[22] Brescia Univ, Unit Blood Dis & Bone Marrow Transplantat, Brescia, Italy

[23] IRCCS Ist G Gaslini, Dept Hematol Oncol, HSCT Unit, Genoa, Italy

[24] Ctr Henri Becquerel, Rouen, France

[25] Leiden Univ Hosp, Leiden, Netherlands

[26] Clin Univ St Luc, Brussels, Belgium

[27] Med Pk Antalya Hosp, Antalya, Turkiye

[28] Jagiellonian Univ Med Collage, Univ Childrens Hosp Krakow, Dept Clin Immunol & Transplantat, Krakow, Poland

[29] Gazi Univ, Fac Med, Ankara, Turkiye

[30] Hosp U Marques de Valdecilla IDIVAL, Santander, Spain

[31] AUSL IRCCS Reggio Emilia, Hematol, Reggio Emilia, Italy

[32] Univ Hosp Maastricht, Maastricht, Netherlands

[33] Univ Saarland, Lorenz Thurner, Homburg, Germany

[34] Gazi Univ, Sch Med, Ankara, Turkiye

[35] Hosp Son Espases, Palma De Mallorca, Balearic Island, Spain

[36] Technion, Rambam Med Ctr, Fac Med, Haifa, Israel

[37] Univ Hosp Children WKZ, Princess Maxima Ctr, Utrecht, Netherlands

[38] Karolinska Univ Hosp, Stockholm, Sweden

[39] Univ V Salute San Raffaele, Milan, Italy

[40] Univ Genoa, Div Infect Dis, Genoa, Italy

[41] Osped Policlin San Martino, Genoa, Italy

[42] Hebrew Univ Jerusalem, Fac Med, Hadassah Med Ctr, Pediat Infect Dis, Jerusalem, Israel

[43] Hosp Princesa, Madrid, Spain

[44] Azienda Osped Univ Integrata, Dept Mother & Child, Pediat Hematol Oncol, Verona, Italy

[45] Charite, Dept Hematol Oncol & Tumorimmunol, Campus Virchow Klinikum, Augustenburger Pl 1, D-13353 Berlin, Germany

[46] Charite Univ Med Berlin, Dept Hematol Oncol & Tumorimmunol, Campus Virchow Clin, Augustenburger Pl 1, D-13353 Berlin, Germany

来源：

ECLINICALMEDICINE | 2024年 / 67卷

关键词：

Invasive; Aspergillosis; Stem cell transplantation; Mortality; SECONDARY ANTIFUNGAL PROPHYLAXIS; HEMATOLOGICAL MALIGNANCIES; NEUTROPENIC PATIENTS; FUNGAL-INFECTION; EXPERIENCE; SOCIETY; IMPACT; BLOOD; HSCT;

D O I：

10.1016/j.eclinm.2023.102393

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background Infections are the main reason for mortality during acute leukaemia treatment and invasive aspergillosis (IA) is a major concern. Allogeneic stem cell transplantation (alloSCT) is a standard therapy and often is the only saving procedure in leukaemia patients. The profound immunodeficiency occurring after alloSCT led to high associated mortality in the past. Therefore, patients with IA were historically considered transplant-ineligible. Recently, there has been improvement of anti-fungal management including novel anti-fungal agents. As a result, more leukaemia patients with IA are undergoing alloSCT. Outcome has not been prospectively assessed. Methods We performed a prospective study in acute leukaemia patients undergoing alloSCT to analyse the impact a prior history of probable or proven IA (pre-SCT IA). The primary endpoint was 1-year non-relapse mortality (NRM). Relapse free survival and overall survival were analysed as secondary endpoints. Findings 1439 patients were included between 2016 and 2021. The incidence of probable or proven pre-SCT IA was (n = 87). The cumulative incidence of 1-year NRM was 17.3% (95% CI 10.2-26.0) and 11.2% (9.6-13.0) for patients and without pre-SCT IA. In multivariate analyses the hazard ratio (HR) for 1-year NRM was 2.1 (1.2-3.6; p = 0.009) patients with pre-SCT IA. One-year relapse-free survival was inferior in patients with pre-SCT IA (59.4% [48.3-68.9] 70.4 [67.9-72.8]; multivariate HR 1.5 [1.1-2.1]; p = 0.02). Consequently, 1-year overall survival was lower in patients with pre-SCT IA: (68.8% [57.8-77.4] vs. 79.0% [76.7-81.1]; multivariate HR 1.7 [1.1-2.5]; p = 0.01). Interpretation Pre-SCT IA remains to be significantly associated with impaired alloSCT outcome. On the other more than two thirds of patients with pre-SCT IA were alive at one year after alloSCT. IA is not anymore an absolute contraindication for alloSCT because the majority of patients with IA who undergo alloSCT benefit from this procedure.

引用

页数：10

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