Journal Article

Impact of Previous Aspergillosis on the Outcome of Bone Marrow Transplantation

F. Offner, C. Cordonnier, P. Ljungman, H. G. Prentice, D. Engelhard, D. De Bacquer, F. Meunier and B. De Pauw

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 26, issue 5, pages 1098-1103
Published in print May 1998 | ISSN: 1058-4838
Published online May 1998 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/520274
Impact of Previous Aspergillosis on the Outcome of Bone Marrow Transplantation

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A retrospective analysis of 48 patients with documented or probable invasive aspergillosis (IA) prior to bone marrow transplantation (BMT) was conducted in 16 centers. Treatment of primary IA was medical in all 48 patients and surgical in 20; clinicoradiological resolution of IA occurred in 30 of 48 patients. Pretransplantation risk factors for relapse IA, total mortality, and IA-related mortality were analyzed by multivariate logistic regression with the following dichotomous risk factors: surgery as part of the initial treatment, resolution of IA by the time of BMT, donor type, conditioning regiment, total-body irradiation, T cell depletion, immunosuppressive therapy, type of antifungal prophylaxis, and growth factor prophylaxis. Conditioning with busulfan/cyclophosphamide was associated with a beneficial outcome for total survival and reduced IA-related mortality. Posttransplantation risk factors such as the development of graft-vs.-host disease (GVHD), therapy for GVHD, and the duration of neutropenia did not have a significant effect on relapse IA, IArelated mortality, or total mortality. The overall incidence of relapse IA was lower than expected (33% [16 of 48 patients]), but the mortality rate among relapsed patients was 88% (14 of 16). Patients receiving prophylaxis with absorbable or intravenous antifungals had less relapses of IA than did those not receiving prophylaxis (12 of 41 vs. four of seven, respectively). This finding reflects the need for better prophylaxis and new antifungal treatments for patients undergoing BMT who have a history of IA.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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