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Influence of invasive aspergillosis during acute leukaemia treatment on survival after allogeneic stem cell transplantation: a prospective study of the EBMT Infectious Diseases Working Party

Abstract: Background: Infections are the main reason for mortality during acute leukaemia treatment and invasive aspergillosis (IA) is a major concern. Allogeneic stem cell transplantation (alloSCT) is a standard therapy and often is the only live-saving procedure in leukaemia patients. The profound immunodeficiency occurring after alloSCT led to high IA-associated mortality in the past. Therefore, patients with IA were historically considered transplant-ineligible. Recently, there has been improvement of anti-fungal management including novel anti-fungal agents. As a result, more leukaemia patients with IA are undergoing alloSCT. Outcome has not been prospectively assessed. Methods: We performed a prospective study in acute leukaemia patients undergoing alloSCT to analyse the impact of a prior history of probable or proven IA (pre-SCT IA). The primary endpoint was 1-year non-relapse mortality (NRM). Relapse free survival and overall survival were analysed as secondary endpoints. Findings: 1439 patients were included between 2016 and 2021. The incidence of probable or proven pre-SCT IA was 6.0% (n = 87). The cumulative incidence of 1-year NRM was 17.3% (95% CI 10.2?26.0) and 11.2% (9.6?13.0) for patients with and without pre-SCT IA. In multivariate analyses the hazard ratio (HR) for 1-year NRM was 2.1 (1.2-3.6; p = 0.009) for patients with pre-SCT IA. One-year relapse-free survival was inferior in patients with pre-SCT IA (59.4% [48.3-68.9] vs. 70.4 [67.9-72.8]; multivariate HR 1.5 [1.1-2.1]; p = 0.02). Consequently, 1-year overall survival was lower in patients with pre-SCT IA: (68.8% [57.8-77.4] vs. 79.0% [76.7-81.1]; multivariate HR 1.7 [1.1-2.5]; p = 0.01). Interpretation: Pre-SCT IA remains to be significantly associated with impaired alloSCT outcome. On the other hand, more than two thirds of patients with pre-SCT IA were alive at one year after alloSCT. IA is not anymore an absolute contraindication for alloSCT because the majority of patients with IA who undergo alloSCT benefit from this procedure.

 Fuente: eClinicalMedicine, 2024, 67, 102393

 Editorial: Elsevier

 Año de publicación: 2024

 Nº de páginas: 10

 Tipo de publicación: Artículo de Revista

 DOI: 10.1016/j.eclinm.2023.102393

 ISSN: 2589-5370

 Url de la publicación: https://doi.org/10.1016/j.eclinm.2023.102393

Autoría

PENACK, OLAF

TRIDELLO, GLORIA

SALMENNIEMI, URPU

MARTINO, RODRIGO

KHANNA, NINA

PERRUCCIO, KATIA

FAGIOLI, FRANCA

RICHERT-PRZYGONSKA, MONIKA

LABUSSIÈRE-WALLET, HÉLÈNE

MAERTENS, JOHAN

JUBERT, CHARLOTTE

ALJURF, MAHMOUD

PICHLER, HERBERT

KRIVÁN, GERGELY

KUNADT, DESIREE

POPOVA, MARINA

GABRIEL, MELISSA

CALORE, ELISABETTA

LUCRECIA YAÑEZ SAN SEGUNDO