RT Journal Article
SR Electronic
T1 Breakthrough invasive pulmonary aspergillosis (IPA) in patients receiving posaconazole prophylaxis (PPxis)
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P4685
VO 44
IS Suppl 58
A1 Patout, Maxime
A1 Fercocq, Chloé
A1 Alanio, Alexandre
A1 Touratier, Sophie
A1 Raffoux, Emmanuel
A1 Derouin, Francis
A1 Molina, Jean-Michel
A1 Bretagne, Stéphane
A1 Ribaud, Patricia
A1 Bergeron, Anne
YR 2014
UL http://erj.ersjournals.com/content/44/Suppl_58/P4685.abstract
AB 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.