Premium
Predicting survival in adults with invasive aspergillosis during therapy for hematological malignancies or after hematopoietic stem cell transplantation: Single‐center analysis and validation of the Seattle, French, and Strasbourg prognostic indexes
Author(s) -
Parody Rocio,
Martino Rodrigo,
Sánchez Ferran,
Subirá Maricel,
Hidalgo Alberto,
Sierra Jorge
Publication year - 2009
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.21488
Subject(s) - hematologic neoplasms , hematopoietic stem cell transplantation , aspergillosis , medicine , hematopoietic cell , transplantation , single center , oncology , overall survival , stem cell , haematopoiesis , immunology , biology , genetics
In this retrospective monocenter study, we analyzed the outcomes of 130 adult hematological patients who developed a proven ( n = 23), probable ( n = 71), and possible ( n = 36) invasive aspergillosis (IA) in a 13‐year period. Forty‐nine patients (38%) were recipients of an allogeneic hematopoietic stem cell transplantation (AlloHSCT). The main goal of the study was the identification of prognostic factors for 4‐month aspergillosis free survival (AFS) and overall survival (OS). IA was identified as the main cause of death in 27/49 recipients of an AlloHSCT (55%) and 28/81 nontransplanted patients (35%). Diagnosis of IA at or before 2000 had a negative impact in both 4‐month AFS and 4‐month OS in the entire group. In multivariate analysis performed separately for nontransplanted and allo‐HSCT patients, five variables (excluding the year of diagnosis) decreased 4‐month AFS: (i) impairment of one organ function (OF), (ii) impairment of two or more OFs (two points), (iii) disseminated IA, (iv) neutropenia lasting more than 10 days (non‐AlloHSCT group only) or monocytopenia (<0.1 × 10 9 /l) [AlloHSCT group only], and (v) high‐dose steroids (non‐AlloHSCT group only) or an alternative donor (AlloHSCT group only). According to the number of adverse risk factors, three prognostic subgroups were defined in non‐transplanted and alloHSCT patients with good (97% and 78% AFS), intermediate (73% and 32% AFS) and poor prognosis (20% and 11% AFS) of IA [ P < 0.01]. In addition, we validated the French and Seattle prognostic indexes for allo‐HSCT recipients and the Strasbourg model for all hematological patients with IA. Am. J. Hematol., 2009. © 2009 Wiley‐Liss, Inc.