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Detection of Invasive Pulmonary Aspergillosis in Haematological Malignancy Patients by using Lateral-flow Technology
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Blastemia portrays a poor prognosis in acute leukemia patients with invasive pulmonary aspergillosis

Sung-Yeon Cho1, Sebastian Wurster2, Ying Jiang2

  • 1Department of Infectious Diseases, University of Texas, MD Anderson Cancer Center, TX, United States; Division of Infectious Diseases, Department of Internal Medicine, Vaccine Bio Research Institute, Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, the Catholic University of Korea, Seoul, South Korea.

The Journal of Infection
|June 18, 2025
PubMed
Abstract

Insights

Blastemia, or high leukemia blast counts in the blood, is common in invasive pulmonary aspergillosis (IPA) and predicts poor outcomes. This finding is crucial even without neutropenia, highlighting blastemia as a key risk factor.

Area of Science:

  • Hematology
  • Mycology
  • Immunology

Background:

  • Invasive pulmonary aspergillosis (IPA) poses a significant threat to leukemia patients, with outcomes often linked to neutropenia.
  • Relapsed/refractory leukemia patients face a high incidence of IPA, necessitating further investigation into prognostic factors beyond neutropenia.

Purpose of the Study:

  • To investigate the association between peripheral blood blast burden (blastemia) and outcomes of IPA in leukemia patients.
  • To explore the impact of blastemia on antifungal immune failure, irrespective of neutropenia status.

Main Methods:

  • Retrospective analysis of adult patients with acute leukemia or myelodysplastic syndrome and proven/probable IPA (2011-2022).
  • Calculation of blast and neutropenia indices, integrated into multivariable prognostic models.
  • In vitro studies to assess the effect of leukemic blasts on immune cell-mediated fungal clearance.

Main Results:

  • Blastemia was present in 57% of the 74 reviewed patients at IPA diagnosis.
  • A high blast index (≥90) and prior chemotherapy lines (≥3) independently predicted 42-day mortality and early antifungal treatment failure.
  • Leukemic blasts demonstrated minimal immune activity against Aspergillus fumigatus and impaired the antifungal function of peripheral blood mononuclear cells.

Conclusions:

  • Blastemia is prevalent in contemporary leukemia patients with IPA and serves as a significant risk factor for adverse outcomes.
  • Blastemia may contribute to poor outcomes by interfering with immune cell-mediated fungal clearance.
  • Blastemia should be incorporated as a risk stratification parameter in future clinical trials and preclinical models for IPA.
Keywords:
Acute leukemiaBlastemiaInvasive pulmonary aspergillosis

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