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Detection of Invasive Pulmonary Aspergillosis in Haematological Malignancy Patients by using Lateral-flow Technology
Published on: March 22, 2012
What Is the Prognostic Significance of Culture-Documented Breakthrough Invasive Pulmonary Aspergillosis in Patients
Sung-Yeon Cho1,2, Sebastian Wurster1, Takahiro Matsuo1
1Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
Abstract:
Mold-active prophylaxis has reduced the incidence of invasive pulmonary aspergillosis (IPA) in patients with hematological malignancies (HMs), but breakthrough IPA (Bt-IPA) is increasingly encountered. Therefore, we studied determinants of Bt-IPA risk and its prognostic significance. We retrospectively reviewed culture-positive proven/probable IPA cases in HM patients at MD Anderson Cancer Center (2016-2021). Bt-IPA and non-Bt-IPA cases were compared to characterize risk factors, clinical presentation, and outcomes. Independent predictors of 42-day all-cause mortality were assessed using propensity score-adjusted Cox regression. Among 118 IPA cases, 50 (42.4%) were Bt-IPA. Bt-IPA was associated with acute leukemia/myelodysplastic syndrome, active HM, severe neutropenia (<100/mm3), and graft-versus-host diseases. Uncommon Aspergillus species (non-fumigatus, flavus, terreus, or niger) were more frequent in Bt-IPA than non-Bt-IPA (20.4% vs. 4.8%, p = 0.010). Forty-two-day mortality was higher in Bt-IPA (65.3% vs. 37.3%, p = 0.003), but Bt-IPA itself was not an independent predictor or mortality (p = 0.064), which was instead driven by neutropenia (p = 0.020) and hypoalbuminemia (p = 0.002). In conclusion, Bt-IPA accounted for nearly half of contemporary IPA cases and was linked to host-related risk factors and the recovery of uncommon Aspergillus species. Although not an independent prognostic predictor, Bt-IPA reflected poor host status. Thus, early diagnosis, immune enhancement strategies, and effective first-in-class antifungals may improve outcomes.
Insights
Breakthrough invasive pulmonary aspergillosis (Bt-IPA) affects nearly half of patients with hematological malignancies despite antifungal prophylaxis. Risk factors include specific cancers and neutropenia, with uncommon Aspergillus species emerging.
Area of Science:
- Medical Mycology
- Hematology
- Infectious Diseases
Background:
- Mold-active prophylaxis has decreased invasive pulmonary aspergillosis (IPA) in hematological malignancy (HM) patients.
- Breakthrough IPA (Bt-IPA) is an increasing challenge in this immunocompromised population.
- Understanding Bt-IPA risk factors and outcomes is crucial for improving patient management.
Purpose of the Study:
- To investigate the determinants of Bt-IPA risk in HM patients.
- To assess the prognostic significance of Bt-IPA on patient outcomes.
- To identify factors associated with mortality in IPA cases.
Main Methods:
- Retrospective review of culture-positive proven/probable IPA cases in HM patients (2016-2021).
- Comparison of Bt-IPA and non-Bt-IPA cases to identify risk factors, clinical features, and outcomes.
- Propensity score-adjusted Cox regression analysis to determine independent predictors of 42-day all-cause mortality.
Main Results:
- Bt-IPA constituted 42.4% of IPA cases.
- Bt-IPA was associated with acute leukemia/myelodysplastic syndrome, active HM, severe neutropenia, and graft-versus-host disease.
- Uncommon Aspergillus species were more frequent in Bt-IPA (20.4% vs. 4.8%).
- 42-day mortality was higher in Bt-IPA (65.3% vs. 37.3%), but neutropenia and hypoalbuminemia were the independent predictors of mortality.
Conclusions:
- Bt-IPA is a significant clinical problem in HM patients, often linked to host-related factors and unusual fungal species.
- While not an independent mortality predictor, Bt-IPA indicates a poorer host status.
- Early diagnosis, immune support, and effective antifungal therapies are essential for improving outcomes in Bt-IPA.
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