Table 1.
Demographic, Clinical, and Laboratory Characteristics of Leukemia Patients With or Without Hematopoietic Stem Cell Transplantation (HSCT) Who Had Invasive Pulmonary Aspergillosis (IPA) Alone or Following a Respiratory Viral Infection (RVI)
| Characteristic | IPA Group (n = 142) | Post-RVI IPA Group (n = 54) | P |
|---|---|---|---|
| Age, y, median (range) | 61 (18–84) | 59 (19–78) | .09 |
| Male sex | 83 (58) | 30 (56) | .71 |
| Former or current smoker | 68 (48) | 22 (41) | .30 |
| Hematologic malignancy | .42 | ||
| AML/MDS | 88 (62) | 27 (50) | |
| ALL | 12 (8) | 7 (13) | |
| CML | 6 (4) | 4 (7) | |
| CLL | 36 (25) | 16 (30) | |
| Malignancy status | .003 | ||
| Remission | 39 (27) | 27 (50) | |
| Active | 103 (73) | 27 (50) | |
| History of HSCT | 52 (37) | 37 (69) | <.0001 |
| HSCT donor | |||
| Allogeneic | 50 (35) | 33 (61) | .22 |
| Autologous | 2 (1) | 4 (7) | .05 |
| Chronic or recurrent GvHD before IPA diagnosis | 33 (23) | 23 (43) | .007 |
| History of immunosuppressant usea | |||
| Cyclophosphamide | 24 (17) | 5 (9) | .18 |
| Cytarabine | 58 (41) | 12 (22) | .015 |
| Fludarabine | 26 (18) | 8 (15) | .56 |
| Tacrolimus | 25 (18) | 27 (50) | <.0001 |
| Mycophenolate mofetil | 9 (6) | 4 (7) | .76 |
| Rituximab | 26 (18) | 6 (11) | .22 |
| Daunorubicin | 30 (21) | 4 (7) | .023 |
| Corticosteroid use (>600 mg prednisone equivalent)b | 49 (35) | 12 (22) | .12 |
| Severe neutropenia >21 d before IPA diagnosisc | 86 (61) | 21 (39) | .007 |
| Underlying medical condition | |||
| Diabetes mellitus | 45 (32) | 20 (37) | .48 |
| Chronic obstructive pulmonary disease | 15 (11) | 6 (11) | .91 |
| Antimicrobial use before IPAd | 126 (89) | 49 (91) | .68 |
| Absolute neutrophil count, neutrophils/µL | |||
| At IPA diagnosis | .05 | ||
| ≤100 | 40 (28) | 12 (22) | |
| 100–500 | 16 (11) | 1 (2) | |
| ≥500 | 86 (61) | 41 (76) | |
| Median (range) | 1.15 (0–31.58) | 2.14 (0–15.60) | .11 |
| At RVI diagnosis, median (range) | NA | 1.15 (0–14.40) | |
| Neutropenia duration at IPA diagnosis, d, median (range) | 78 (5–636) | 85 (2–344) | .96 |
| Absolute lymphocyte count, lymphocytes/µL | .26 | ||
| At IPA diagnosis | |||
| ≤100 | 37 (26) | 13 (24) | |
| 100–500 | 46 (32) | 12 (22) | |
| ≥500 | 59 (42) | 29 (54) | |
| Median (range) | 0.41 (0–49.60) | 0.57 (0–44.80) | .58 |
| At RVI diagnosis, median (range) | NA | 0.45 (0–303.0) | |
| Monocyte count at RVI diagnosis, monocytes/µL | .054 | ||
| ≤100 | 99 (70) | 45 (83) | |
| >100 | 43 (30) | 9 (17) | |
| IgG gamma globulin level at IPA diagnosis, mg/dL, median (IQR) | 651 (185–2863) | 692 (134–2040) | .85 |
| Malnutrition (serum albumin level, <3.0 g/dL) at IPA diagnosis | 90 (63) | 30 (56) | .32 |
| Galactomannan Ag OD ≥0.7 at IPA diagnosis | |||
| In serum | 63 (44) | 27 (50) | .48 |
| In BAL | 8 (6) | 5 (9) | .35 |
| Prior active triazole-based exposure before IPA diagnosise | 50/74 (68) | 27/28 (96) | .0017 |
| Duration of prior exposure to Aspergillus-active antifungal drugs, d, median (IQR) | 65 (26–141) | 142 (81–301) | <.001 |
| Coinfection with bacteremia at IPA diagnosis | 6 (4) | 15 (28) | <.0001 |
Data are no. (%) of patients, unless otherwise indicated.
Abbreviations: Ag, antigen; ALL, acute lymphocytic leukemia; AML, acute myeloid leukemia; BAL, bronchoalveolar lavage; CLL, chronic lymphocytic leukemia; CML, chronic myeloid leukemia; GvHD, graft-versus-host disease; IQR, interquartile range; MDS, myelodysplastic syndrome; NA, not applicable.
aDefined as immunosuppressant use ≤12 weeks before IPA diagnosis.
bDefined as corticosteroid use (0.3 mg/kg per day prednisone equivalent) >21 days before IPA diagnosis.
cDefined as an absolute neutrophil count of <500 neutrophils/μL for at least 21 days before IPA diagnosis.
dDefined as antimicrobial prescription ≤3 months before IPA diagnosis.
eTriazole-based treatment for IPA was received by 74 controls and 28 cases.