The aim of this study was to evaluate prognostic factors, treatments and outcome of invasive
aspergillosis in patients with acute myeloid leukemia based on data collected in a registry.
Design and Methods
The registry, which was activated in 2004 and closed in 2007, collected data on patients with
acute myeloid leukemia, admitted to 21 hematologic divisions in tertiary care centers or university
hospitals in Italy, who developed proven or probable invasive aspergillosis.
One hundred and forty cases of invasive aspergillosis were collected, with most cases occurring
during the period of post-induction aplasia, the highest risk phase in acute myeloid
leukemia. The mortality rate attributable to invasive aspergillosis was 27%, confirming previous
reports of a downward trend in this rate. Univariate and multivariate analyses revealed that
the stage of acute myeloid leukemia and the duration of, and recovery from, neutropenia were
independent prognostic factors. We analyzed outcomes after treatment with the three most
frequently used drugs (liposomal amphotericin B, caspofungin, voriconazole). No differences
emerged in survival at day 120 or in the overall response rate which was 71%, ranging from
61% with caspofungin to 84% with voriconazole.
Our series confirms the downward trend in mortality rates reported in previous series, with all
new drugs providing similar survival and response rates. Recovery from neutropenia and disease
stage are crucial prognostic factors. Efficacious antifungal drugs bridge the period of maximum
risk due to poor hematologic and immunological reconstitution.
|Numero di pagine||7|
|Stato di pubblicazione||Pubblicato - 2009|