Tuberc Respir Dis.  2012 Mar;72(3):284-292.

Prognosis of Invasive Pulmonary Aspergillosis in Patients with Hematologic Diseases in Korea

• Kwon JC
• Kim SH
• Park SH
• Choi SM
• Lee DG
• Choi JH
• Yoo JH
• Kim YJ
• Lee S
• Kim HJ
• Lee JW
• Min WS

Abstract

BACKGROUND
The aim of this study was to investigate therapeutic outcomes and assess factors associated with therapeutic outcomes in hematologic patients with invasive pulmonary aspergillosis (IPA).
METHODS
We analyzed all consecutive cases of IPA in adults with hematologic diseases from January 2008 to January 2009 at a Catholic Hematopoietic Stem Cell Transplantation (HSCT) Center in Seoul, Korea.
RESULTS
A total of 54 patients were identified. Underlying diseases were acute myelogenous leukemia (n=25), acute lymphoblastic leukemia (n=10), myelodysplastic syndrome (n=7), chronic myelogenous leukemia (n=3), multiple myeloma (n=3), severe aplastic anemia (n=2) and other hematologic diseases (n=4). Twenty six patients (48.2%) were assessed as having a favorable response, of which 16 patients (29.6%) showed complete response. Overall 12-week mortality and IPA attributable mortality were 38.9% (n=21) and 33.3% (n=18), respectively. In multivariate analysis, uncontrolled underlying disease (odds ratio [OR], 7.31; 95% confidence interval [CI], 1.49~35.94; p=0.014) was associated with an unfavorable response, and for 12-week mortality, uncontrolled underlying disease (OR, 11.79; 95% CI, 1.49~93.46; p=0.020) and hypoalbuminemia (OR, 9.89; 95% CI, 1.42~68.99; p=0.021) were significantly poor prognostic factors.
CONCLUSION
IPA still remains as a poor therapeutic outcome, especially in patients with refractory hematologic diseases.

Keyword

Invasive Pulmonary Aspergillosis; Prognosis; Hematology; Mortality

MeSH Terms

Adult
Anemia, Aplastic
Hematologic Diseases
Hematology
Hematopoietic Stem Cell Transplantation
Humans
Hypoalbuminemia
Invasive Pulmonary Aspergillosis
Korea
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Leukemia, Myeloid, Acute
Multiple Myeloma
Multivariate Analysis
Myelodysplastic Syndromes
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Prognosis

Figure

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  Figure 1 Treatment outcome and enrollment of invasive pulmonary aspergillosis according to the type of antifungal therapy used. IPA: invasive pulmonary aspergillosis; FR: favorable response; UR: unfavorable response; CR: complete response; PR: partial response; SD: stable disease.

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  Figure 2 Kaplan-Meier probability of overall survival after initiation of the first antifungal therapy. Solid line (A) indicates survival probability of patients (n=36) with remission or no evidence of relapse. Dotted line (B) indicates that of patients (n=18) with relapse or receiving conservative care only (median, 34 days; 95% confidence interval, 22~46 days).

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