Table 2.
Characteristics and posttransplantation outcomes of invasive aspergillosis
| All patients | RIC | Conventional | P* | |
|---|---|---|---|---|
| No. patients | 129 | 57 | 72 | |
| Classification by the EORTC-MSG criteria, no. (%) | ||||
| Proven | 49 (38) | 12 (21) | 37 (51) | .01 |
| Probable | 80 | 45 | 35 | |
| Aspergillus species involved, no. (%) | ||||
| A fumigatus | 40 (31) | 11 (19) | 29 (40) | |
| A flavus | 3 (2) | 1 (2) | 2 (3) | |
| A terreus | 2 (1) | 1 (2) | 1 (1) | |
| A niger | 3 (2) | 2 (4) | 1 (1) | |
| Nonspeciated species | 38 (29) | 20 (35) | 18 (25) | |
| GM positive† | 44 (34) | 23 (40) | 21 (29) | |
| Sites involved, no. (%) | ||||
| Pulmonary with or without other | 117 (91) | 53 (93) | 64 (89) | |
| Extrapulmonary | 12 | 4 | 8 | |
| Time interval from start TxIA-Allo-HSCT, median d (range) | 101 (9-378) | 98 (58-371) | 103 (9-378) | |
| Less than 6 wk, no. (%) | 18 (14) | 9 (16) | 9 (11) | |
| 6 wk to 3 mo, no. (%) | 38 (29) | 15 (26) | 23 (32) | |
| 3 to 6 mo, no. (%) | 43 (33) | 19 (33) | 24 (33) | |
| 6 to 12 mo, no. (%) | 30 (23) | 14 (25) | 16 (22) | |
| Status of IA at Allo-HSCT, no. (%) | .06 | |||
| Complete remission | 58 (45) | 21 (37) | 37 (51) | |
| Partial remission | 50 (39) | 29 (51) | 21 (29) | |
| Stable disease | 17 (13) | 5 (9) | 12 (17) | |
| Progression | 4 (3) | 2 (3) | 2 (3) | |
| Surgical resection before allo-HSCT, no. (%) | 28 (22) | 4 (7) | 24 (33) | < .01 |
| No. GM positive (serum index ≥ 0.8 × 2 samples) at allo-HSCT/no. tested (%) | 5/53 (9) | 4/23 (17) | 1/30 (3) | .02 |
| New (breakthrough) IFI after allo-HSCT, no. (%)‡ | 3 (2) | 1 (2) | 2 (3) | |
| Final response of IA after allo-HSCT, no. (%) | ||||
| Stable disease | 58 (45) | 24 (42) | 34 (47) | |
| Improvement after transplantation | 44 (34) | 20 (35) | 24 (33) | |
| Progression | 27 (21) | 13 (23) | 14 (19) | |
| Incidence of progression of IA, no. (95% CI) | ||||
| 1 mo | 10 (2-24) | 7 (1-12) | 15 (5-24) | |
| 6 mo | 15 (8-22) | 12 (3-21) | 16 (7-39) | |
| 2 y | 22 (14-30) | 22 (8-32) | 21 (9-33) | |
| Response to salvage AFT of IA that progressed after allo-HSCT, no. (%) | 6/27 (22) | 5/13 (39) | 1/14 (7) | .08 |
| Deaths related to IA, no. (CumInc)§ | 21 (14) | 6 (18) | 15 (18) | .16* |
| Deaths related to IA/total deaths (%)§ | 21/73 (29) | 6/31 (19) | 15/42 (36) | .1 |
| Death related to any IFI (CumInc)§ | 24 (15) | 7 (9) | 17 (23) | .11* |
TxIA-allo-HSCT indicates time interval from start of antifungal therapy for IA and allo-HSCT.
All P values were calculated with the chi-square statistic or Fisher exact test except for comparisons of cumulative incidence estimates, which were compared with a univariate Cox regression model (detailed in “Statistical analysis”).
GM positivity in serum (index ≥ 0.8 twice) without culture isolation of the causative species. An additional 24 patients had positive GM in serum and isolation of the causative Aspergillus spp, and 1 patient had 2 species isolated from the same sample (A fumigatus and A niger).
All breakthrough infections occurred under systemic antifungal secondary prophylaxis. One patient on voriconazole developed proven disseminated fusariosis, 1 on itraconazole developed a central nervous system infection from an unidentified fungus with pseudohyphae, and 1 patient on itraconazole developed proven pulmonary zygomycosis.
All outcomes analyzed at 2 years after transplantation.