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Blood, 1 November 2006, Vol. 108, No. 9, pp. 2928-2936.
Prepublished online as a Blood First Edition Paper on May 23, 2006; DOI 10.1182/blood-2006-03-008706.
 Previous Article | Table of Contents | Next Article 
CLINICAL TRIALS AND OBSERVATIONS
Impact of the intensity of the pretransplantation conditioning regimen in patients with prior invasive aspergillosis undergoing allogeneic hematopoietic stem cell transplantation: a retrospective survey of the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation
Rodrigo Martino,
Rocio Parody,
Takahiro Fukuda,
Johan Maertens,
Koen Theunissen,
Aloysius Ho,
Ghulam J. Mufti,
Nicolaus Kroger,
Arnold R. Zander,
Dominik Heim,
Monika Paluszewska,
Dominik Selleslag,
Katerina Steinerova,
Per Ljungman,
Simone Cesaro,
Anna Nihtinen,
Catherine Cordonnier,
Lourdes Vazquez,
Monica López-Duarte,
Javier Lopez,
Rafael Cabrera,
Montserrat Rovira,
Stefan Neuburger,
Oliver Cornely,
Ann E. Hunter,
Kieren A. Marr,
Hans Jürgen Dornbusch, and
Hermann Einsele
From the Hematology Departments of Sant Pau Hospital, Autonomous University of Barcelona, Spain; Fred Hutchinson Cancer Research Center, Seattle, WA; University Hospital Gasthuisberg, Leuven, Belgium; King's College London School of Medicine, London, United Kingdom; UKE Hamburg, Germany; University Hospital of Basel, Switzerland; Medical University of Warsaw, Poland; AZ Sint Jan, Brugge, Belgium; Charles University Hospital, Pilsen, Czech Republic; Karolinska University Hospital, Stockholm, Sweden; Pediatric Hematology/Oncology, Department of Pediatrics, University of Padua, Italy; University Central Hospital of Helsinki, Finland; Henri Mondor Hospital, Creteil, France; Clinical Hospital of Salamanca, Spain; Marqués de Valdecilla Hospital, Santander, Spain; Ramón y Cajal Hospital, Madrid, Spain; Puerta de Hierro Hospital, Madrid, Spain; Wuerzburg University Medical Center, Wuerzburg, Germany; Clinic Hospital of Barcelona, Spain; Charité Campus Virchow Klinikum, Berlin, Germany; University Hospital Cologne, Germany; University Hospital of Leicester, United Kingdom; Division of Pediatric Hematology and Oncology, Medical University of Graz, Austria; and the Hematopoietic Stem Cell Transplantation Unit, National Cancer Center Hospital, Tokyo, Japan.
In this retrospective study, we analyzed the outcomes of 129 patients who underwent an allogeneic hematopoietic stem cell transplantation (allo-HSCT) and had a history of probable or proven invasive aspergillosis (IA), of whom 57 (44%) received a reduced-intensity conditioning (RIC). Overall, 27 patients with IA progressed after the allo-HSCT (cumulative incidence [CumInc] at 2 years, 22%). The variables that increased the 2-year CumInc of IA progression were (1) longer duration of neutropenia after transplantation; (2) advanced status of the underlying disease; and (3) less than 6 weeks from start of systemic anti-Aspergillus therapy and the allo-HSCT. In addition, (4) conventional myeloablative conditioning increased the risk of progression early after transplantation (before day 30) only, while 3 variables increased the risk beyond day 30 were (5) cytomegalovirus disease; (6) bone marrow or cord blood as source of stem cells; and (7) grades II to IV acute graft-versus-host disease (GVHD). A risk model for progression was generated, defined as low (0-1 risk factors, 6% incidence), intermediate (2-3 risk factors, 27% incidence), or high risk ( 3 risk factors, 72% incidence [P < .001]). These findings may help in the interpretation and design of future studies on secondary prophylaxis of IA after an allo-HSCT.
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