ALBERT

Description: Background : Introducing a new antifungals and diagnostic procedures has improved prognosis of the invasive aspergillosis (IA) in hematological patients. The number of patients with IA who are candidates for allogeneic hematopoietic stem cell transplantation (allo-HSCT) has increased. The influence of IA on survival and on allo-HSCT related complications has not been investigated in a prospective study. Aim: to estimate impact of prior proven and probable IA on outcome of allo-HSCT compared to patients without IA. Methods: In prospective observational single center study 362 allo-HSCT recipients (336 - first and 26 - second allo-HSCT) were included from Jan 2012 to Dec 2014. The median age was 34 y, males - 54%. Most of pts had high-risk acute leukemia (70%). Allo-HSCT with MUD were performed in 57%, MRD - 24%, haplo - 11%, MMUD - 8%, predominantly with RIC (80%). All patients with lesions in CT scan before allo-HSCT have undergone bronchoscopy with BAL microscopy, culture and GM test. EORTC/MSG 2008 criteria were used for the diagnosis of proven and probable IA as well as to evaluate response to therapy. "Active" invasive IA - IA diagnosed just before allo-HSCT. All patients were observed with the median 2 years follow up. We analyze status of pts before HSCT, donor types, source of HSCT, CMV status, conditioning regimens and type of immunosuppression, relapse or progression of IA, relapse of underlying disease, duration of antifungal therapy and prophylaxis, acute and chronic GvHD. The cumulative incidences were determined with cumulative incidence method. Differences between the two cohorts were verified with Gray test. Overall survival after allo-HSCT was estimated with Kaplan-Meier method and cohorts were compared by log-rank test. Results: Incidence of IA before allo-HSCT was 20% (n=72/362). According to EORTC/MSG 2008 criteria 92% of pts had probable IA and 8% - proven IA. The main sites of IA were lungs - 95%, central nervous system - 3%, and colon - 3%, other sites were observed in a combination with lungs involvement: sinuses - 5%, spleen - 3%, and liver - 3%. The median time from IA to allo-HSCT was 3 months (3 days - 30 months). Antifungal therapy before allo-HSCT was used in 69% pts (voriconazole - 95%, other - 5%) with the median duration of therapy - 2 months. Complete response to antifungal therapy was registered in 19 (26%) patients, partial response or stabilization - 31 (43%), and "active IA" - 22 (31%). After allo-HSCT all patients received antifungal therapy with voriconazole (first line - 31%, continuation of treatment - 43%, and secondary prophylaxis - 26%). Median length of treatment was 166 days (37 - 394) with the median duration to effect 99 days (31 - 217). No toxicity of the antifungal treatment was registered. Cumulative incidence of relapse or progression of IA at 2 year after allo-HSCT was 14% (n=10). "Active" underlying disease before D+100 post transplant was the only risk factor for the relapse or progression of IA after allo-HSCT (6% vs 33%, p=0,007). 100-days OS after allo-HSCT was 77%, 2-year OS after allo-HSCT was 62%. There was no significant difference in OS in patients with or without IA prior to allo-HSCT (57% vs 65%, p=0,3). Duration of antifungal therapy before HSCT (

Description: Background. In the expanding population of immunocompromised patients rare fungi have emerged as important pathogens, causing invasive infections associated with high morbidity and mortality. The number of publications on the invasive fungal diseases caused by rare pathogens (rare IFD) after hematopoietic stem cell transplantation (HSCT) and chemotherapy is limited. Patients and methods. We design the retrospective study in order to investigate the epidemiology of rare IFD in large cohort of patients after HSCT and chemotherapy for 11-year period. From 2008 to 2018 in R. Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation (CIC725) were performed 3209 HSCT including 2118 allogeneic (allo-HSCT) and 1037 autologous HSCT (auto-HSCT). During the observation period 41 probable and proven rare IFD (EORTC/MSG 2008 criteria) cases were diagnosed in children and adults with hematological malignances and non-malignant hematological diseases after allo-HSCT (n=30), auto-HSCT (n=2), and chemotherapy (n=9). The median age was 24 (2-59) y.o., males - 61%(n=25). The median follow up time for rare IFD cases was 3 months; for survivors - 30 months. Results. Incidence of rare IFD in HSCT recipients was 1,3%, it was higher after allo-HSCT (1,4%) than auto-HSCT (0,2%) (p