Abstract 1384

Poster Board I-406

Invasive fungal infections (IFI) contribute significantly to mortality and morbidity in patients receiving myelosuppressive chemotherapy for hematological malignancies. The present study evaluates the incidence of IFI, the overall survival (OS), the infection-related mortality and changes in treatment of IFI in our department from 1995 until 2006. Data of all consecutive chemotherapy courses were retrospectively collected with a standard questionnaire. EORTC/MSG criteria for IFI were applied with a modification: A positive PCR-result for Aspergillus spp. in bronchoalveolar lavage was also defined as probable IFI. In total, 1693 courses of 592 patients were evaluated. Sixty-three percent were given to treat acute myeloid leukemia, the rest for acute lymphoblastic leukemia or aggressive lymphoma. IFI were observed in 139/592 patients (23%, 95% confidence interval (CI) 20-27%), and in 149/1693 (8.8%, 95%CI 8-10%) courses. IFI-related mortality was 57% in 1995-2001 and 29% in 2002-2006, p<0.001. Accordingly, median OS in patients with IFI increased in the later years: 54 days (95%CI 26–82 days) in 1995-2001 versus 229 days (95% CI 35–423 days) in 2002-2006, p=0.001, figure 1. By multivariate analysis, factors predictive for better OS were controlled disease after chemotherapy (hazard ratio (HR) 0.226, p<0.001), possible IFI (in contrast to proven/probable IFI, HR 0.511, p=0.002), age < 60 years (HR 0.611, p=0.015), and use of novel antifungals (HR 0.493, p=0.002). In conclusion, IFI-related mortality decreased and OS in patients with IFI increased significantly in recent years compared to 1995-2001. In our cohort improved OS was associated with controlled underlying disease, certainty of IFI diagnosis (possible), younger age, and the use of novel antifungal agents.

Figure 1
Figure 1. p=0.001
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p=0.001

Time period       
········ 2002-2006       
—— 1995-2001       
Number at risk       
2002-2006 78 28 18 9 6 2 
1995-2001 61 8 6 5 5 5 
Time period       
········ 2002-2006       
—— 1995-2001       
Number at risk       
2002-2006 78 28 18 9 6 2 
1995-2001 61 8 6 5 5 5 
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Disclosures:

von Lilienfeld-Toal: MSD: Honoraria, Research Funding. Glasmacher: Celgene: Employment, Equity Ownership. Hahn-Ast: MSD: Research Funding.

Topics:
chemotherapy regimen, mycoses, tertiary care hospitals, antifungal agents, acute lymphocytic leukemia, bronchial lavage, hematologic neoplasms, infections, leukemia, myelocytic, acute, non-hodgkin's lymphoma, aggressive

Author notes

*

Asterisk with author names denotes non-ASH members.

© 2009 by The American Society of Hematology
2009
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