Table 4.
Prognostic Factors for Invasive Aspergillosis Among Patients With Hematologic Cancers: Findings of Our Current Study in the Context of Prior Reports
| Author, Year | Episodes of IA, No. | Setting | Treatment | Factors Associated With Poor Outcome |
||
|---|---|---|---|---|---|---|
| At Baseline | Nonbaseline, Before IA | Nonbaseline, After IA | ||||
| Present study | 98 | Multiple myeloma with neutropenia | Chemotherapya and ASCT | Platelet count <65,000 platelets/mm3, creatinine clearance rate <53 mL/min | None | Positive s-GMI after 7 days from first positive s-GMI, persistent neutropenia |
| Acute leukemia receiving conventional chemotherapy | ||||||
| Ribrag, 1993 [2] | 21 | Acute leukemia | Chemotherapya | Leukemia not in remission | None | None |
| Pagano, 2010 [14] | 140 | AML | Chemotherapya | Leukemia not in remission | None | Persistent neutropenia |
| Allo-SCT | ||||||
| Ribaud, 1999 [3] | 27 | Hem Ca | Allo-SCT | None | Cumulative prednisone dose ≥7 mg/kg 1 week before IA | GVHD acute (grade ≥2) or extensive chronic |
| Cordonnier, 2006 [6] | 51 | Hem Ca | Allo-SCT (41), ASCT (10) | Age 12–35 years (vs <12, 36–47, and >47 years) | None | Diffuse (vs localized) lung infiltrates, pleural effusion, receipt of ≥2 mg/kg of corticosteroids at IA |
| Upton, 2007 [7] | 405 | Hem Ca | Allo-SCT (391), ASCT (24) | Pulmonary dysfunction, HLA-mismatch, NMA regimen | Total bilirubin level >6.5 mg/dL and creatinine level >2.5 mg/dL ≤7 days before IA diagnosis; 75% of patients had late IA | Late IA (>40 days after SCT), neutropenia at diagnosis of IA, receipt of ≥2 mg/kg of prednisone 1 week after IA diagnosis, disseminated IA |
| Mikulska, 2009 [17] | 45 | Hem Ca | Allo-SCT | Conditioning without ATG | None | Receipt of corticosteroids, low platelet count, low serum IgA level or creatinine level >1.5 mg/dL |
| Baddley, 2010 [12] | 642 | Various diseases | Allo-SCT (337), ASCT (78), SOT (227) | None | Neutropenia ≤30 days before IA diagnosis | Renal insufficiency, liver insufficiency or receipt of corticosteroids, late IA (>30 days after SCT), proven IA |
| Allo-SCT and conventional chemotherapy | ||||||
| Yeghen, 2000 [4] | 87 | Hem Ca | Allo-SCT (32), ASCT (4), chemotherapya (51) | Relapsed malignancy | None | Diffuse (vs localized) lung infiltrates |
| Subira, 2002 [5] | 41 | Hem Ca | Allo-SCT (12), ASCT (3), chemotherapya (24) | Allo-SCT | Persistent neutropenia | |
| Gallien, 2008 [8] | 34 | Hem Ca (26), HIV infection (7), diabetes mellitus (1) | Allo-SCT (18), ASCT (2), chemotherapya (5), others (9) | None | Neutropenia for ≥10 days ≤60 days before IA diagnosis | None |
| Nivoix, 2008 [9] | 289 | Mixed (192 Hem Ca), nonmalignant conditions (21), others | Allo-SCT (41), SOT (10), others | Allo-SCT, prior noninfectious respiratory disease | None | Progression of underlying cancer, ≥0.2 mg/kg of corticosteroids on day of IA diagnosis, disseminated IA, diffuse lung involvement, proven or probable IA (vs possible), creatinine clearance rate <60 mL/min, neutropenia (<500 neutrophils/mm3) ≤4 days after start of IA treatment |
| Parody, 2009 [10] | 130 | Hem Ca | Allo-SCT (49), chemotherapya (81) | Alternative donor for allo-SCT group | None | Disseminated IA, organ impairment, severe cytopenias, and receipt of ≥2 mg/kg/day of corticosteroids at IA diagnosis |
| Reuter, 2009 [11] | 212 | Hem Ca | Allo- and ASCT (49), chemotherapya (163) | None | None | Extrapulmonary disease, duration of neutropenia |
| Koo, 2010 [22] | 93 | Mixed population (58 Hem Ca), solid tumor (6), others | Allo-SCT (34), SOT (11), others | Receipt of 0.3 mg/kg/day prednisone for >3 weeks ≤90 days before IA | None | High s-GMI at IA diagnosis, low s-GMI decayb |
| Ramos, 2011 [16] | 44 | Hem Ca | Allo-SCT (140), ASCT (32), chemotherapya (277) | None | None | Persistent neutropenia, ICU admission, therapy with agents other than antimold azoles |
Variables were defined at baseline (before chemotherapy); nonbaseline, before IA (ie, after the start of chemotherapy but before IA diagnosis); and nonbaseline, after IA (ie, after IA diagnosis).
Abbreviations: Allo-SCT, allogeneic SCT; AML, acute myelogenous leukemia; ASCT, autologous SCT; ATG, antithymocyte globulins; CNS, central nervous system; GVHD, graft-versus-host disease; Hem Ca, hematologic cancer; HIV, human immunodeficiency virus; HLA, human leukocyte antigen; IA, invasive aspergillosis; ICU, intensive care unit; IgA, immunoglobulin A; NMA, nonmyeloablative; SCT, stem cell transplantation; s-GMI, serum Aspergillus galactomannan index; SOT, solid organ transplantation.
a Myelosuppressive but not myeloablative.
b Decay calculated by dividing the difference between baseline s-GMI and s-GMI obtained around 1 week after the first positive s-GMI.