Abstract
Introduction:
PPxis is used to prevent IPA in patients with high-risk haematological malignancies. The aim of this study was to assess the incidence and to describe the clinical presentation of IPA under PPxis.
Methods: 6-year retrospective monocentric study (2007-2013).
Results:
40 (7.8%) patients (pts) among 514 with PPxis developed IPA. IPA was proven (n=2), probable (n=21) or possible (n=17) using the EORTC/MSG 2008 criteria. Underlying diseases were acute myeloid leukaemia (n=27), other myeloid malignancies (n=10), non-Hodgkin lymphoma (n=3). 10 pts were allogeneic transplant recipients (median time from transplant to IPA: 146 days [IQR: 116-316]). Median duration of PPxis courses was 16 days [10–34]. Plasma posaconazole concentration (Cmin) was below 0.5mg/l in 13 of the 25 assessed pts. 33 pts had neutropenia, with a median duration of 20 days [13–44] before IPA diagnosis. 39 pts had a CT-scan at IPA diagnosis, showing nodules (n= 35) with a halo sign (n=28). Serum galactomannan(GM) was positive in 16/40 pts. Bronchoscopy was performed in 22 pts: Aspergillus was recovered in 6 cases (A. fumigatus n=5) and BAL GM was positive in 9/20 cases. Antifungal initial salvage treatment consisted in voriconazole (n=20), voriconazole and caspofungin (n=7), liposomal amphotericin B (n=9) and caspofungin (n=4). The overall complete and partial responses rate was 70% and 30-day mortality was 12.5%. However, median survival after IPA diagnosis was only 128 days [24-415].
Conclusion:
This study suggests that breakthrough IPA in pts receiving PPxis is not such a rare event in high-risk pts. Although a favorable response to salvage antifungal therapy can occur, overall survival appears poor.
- © 2014 ERS
