Abstract
Abstract 3687
Poster Board III-623
Invasive Aspergillosis (IA) has represented a threat for patients and physicians for many years. This is especially true for patients with hematologic malignancies. Several new antifungal agents with broad antifungal activity became available in 2000 ushering in a new millennium with hopes that with this new armamentarium of antifungal drugs will decrease mortality due to IA and perhaps even prevent them better. Mortality rates due to IA have been described in recent reports as acceptable and even in some cancer centers significantly lower than before. The objective of the present study was to evaluate IA in patients with hematologic malignancies in the leukemia department at MDACC during the past 10 years (1998 to 2007) and compare the incidence and mortality rates between these two times periods.
retrospective review of all patients that presented at the leukemia department at MDACC from January 1998 to December 2007. Proven or probable IA was defined as per EORTC criteria.
From 1998 to 2007, 12,845 patients were presented to our department, including 4,243 pts with acute myelogenous leukemia (AML); 940 with acute lymphocytic leukemia (ALL); 3,642 with chronic lymphocytic leukemia (CLL); and 4,276 with other type of leukemia (chronic myelocytic leukemia, low risk-myelodysplastic syndrome and miscellaneous). Overall median age was 58 (range 17-83); 60% were male, 83% did not have history of diabetes mellitus; 71% were neutropenic (ANC < 500) at the moment of the infection; and 11% had a previous bone marrow transplantation.
The overall incidence of IA has significantly decreased from 4 % to 2% over the 10 study years (p= 0.005, IRR=0.45), however, the overall mortality rate (60%) has not decreased significantly. Comparison between the incidence of IA and mortality in the different subsets of patients between 1998-1999 and 2000-2007 is shown in Table 1
| IA . | Old millennium (1998-1999) . | New millennium (2000-2007) . | P value . |
|---|---|---|---|
| Overall incidence | 82 (4%) | 229 (2%) | <0.001 |
| Overall mortality | 55 (67%) | 133 (58%) | 0.153 |
| AML | 37 (6%) | 94 (3%) | <0.001 |
| Incidence Mortality | 28 (77%) | 63 (67%) | 0.332 |
| ALL | 18 (11 %) | 41 (5%) | <0.004 |
| Incidence Mortality | 11 (61%) | 26 (3%) | 0.865 |
| CLL | 18 (3%) | 70 (2%) | 0.298 |
| Incidence Mortality | 11 (61%) | 34 (49%) | 0.342 |
| Others | 9 (1%) | 24 (0.6%) | 0.165 |
| Incidence Mortality | 5 (56%) | 10 (42%) | 0.478 |
| IA . | Old millennium (1998-1999) . | New millennium (2000-2007) . | P value . |
|---|---|---|---|
| Overall incidence | 82 (4%) | 229 (2%) | <0.001 |
| Overall mortality | 55 (67%) | 133 (58%) | 0.153 |
| AML | 37 (6%) | 94 (3%) | <0.001 |
| Incidence Mortality | 28 (77%) | 63 (67%) | 0.332 |
| ALL | 18 (11 %) | 41 (5%) | <0.004 |
| Incidence Mortality | 11 (61%) | 26 (3%) | 0.865 |
| CLL | 18 (3%) | 70 (2%) | 0.298 |
| Incidence Mortality | 11 (61%) | 34 (49%) | 0.342 |
| Others | 9 (1%) | 24 (0.6%) | 0.165 |
| Incidence Mortality | 5 (56%) | 10 (42%) | 0.478 |
The incidence of IA decreased significantly between the two time periods only in patients with AML and in patients with ALL (p<0.001 and 0.004, respectively). However, although there has been a reduction in the mortality rate in all the subsets of patients in the two periods, this difference is not significant.
Overall, A. fumigatus was the pathogen more frequently isolated (30%), followed by A. flavus (21%), A. terreus (18%) and A. niger (11%). In 10% of the episodes more than one Aspergillus species was isolated.
In conclusion, our data suggests that the incidence of IA in patients with leukemia traditionally at high risk for IA has significantly decreased since 2000. Despite the availability of new antifungal drugs for the treatment of IA, the mortality rate in patients with hematological malignancies has not significantly decreased.
Mattiuzzi:Merck: Research Funding.
Author notes
Asterisk with author names denotes non-ASH members.
