Invasive aspergillosis in haematological malignancies: clinical findings and management for intensive chemotherapy completion.

摘要: Sixty-one cases of Aspergillus infection (35 acute myeloid leukemia, 15 lymphoid one myelodysplastic syndrome, two aplastic anemia, eight non-Hodgkin's lymphoma) seen in our department between January 1989 and July 1999 were studied retrospectively to evaluate the clinical characteristics, ascertain factors that influenced outcome from mycotic infections, whether early diagnosis prolonged therapy permitted completion scheduled intensive chemotherapy bone marrow transplantation (BMT) without fungal recurrence. The patients divided into three diagnostic categories: proven aspergillosis (autoptic or histologic diagnosis) n = 39, probable (radiological with positive microbiology) 9, possible alone) 13. In same period among 675 leukemia incidence was 7.1%. At onset 92% neutropenic (< 0.5 × 109/L). most frequent site lung (90%); disseminated disease present 20 patients. Among 44 assessable patients, 12 (27%) failed respond antifungal died. Thirty-two cured treatment, five nonneutropenic only itraconazole, others amphotericin B 1 mg/Kg/day itraconazole subsequently liposomal amphotericin, Ambisome, if renal toxicity occurred. Twenty-four 29 responders, all affected by continued chemotherapies. Pulmonary lobectomy successfully combined medical treatment before BMT. After nine submitted BMT (six allo, unrelated donor (MUD), auto) Ambisome as secondary prophylaxis relapse (follow-up: 25–99 months). median time transplant months, range 3–10. Thirteen surviving had relapse, but (23%) these showed also conclusion, a high index suspicion careful radiological examinations are key identifying infected programming following therapeutic steps. Above prompt aggressive administration agents seems improve invasive permit transplant. Am. J. Hematol. 68:231–236, 2001. © 2001 Wiley-Liss, Inc.