Invasive Pulmonary Aspergillosis: Comparative Analysis in Cancer Patients with Underlying Haematologic Malignancies Versus Solid Tumors.

Invasive Pulmonary Aspergillosis: Comparative Analysis in Cancer Patients with Underlying Haematologic Malignancies Versus Solid Tumors.

J Hosp Infect. 2019 Oct 01;:

Authors: Dib RW, Khalil MC, Fares J, Hachem RY, Jiang Y, Chaftari AM, Raad II

Abstract
BACKGROUND: Invasive pulmonary aspergillosis (IPA) is commonly associated with haematologic malignancies but also occurs with solid tumors.
AIM: Comparing the diagnostic approaches and therapeutic outcomes for IPA between patients with haematologic malignancies and solid cancers.
METHODS: We conducted a retrospective study evaluating consecutive cases of proven and probable IPA from 2004 to 2016. We included patients >18 years old with an underlying solid tumor, haematologic malignancy, or haematopoietic cell transplantation (HCT) within 1 year of IPA diagnosis.
FINDINGS: Of the 311 patients analyzed, 225 had haematologic malignancies and 86 had solid tumors. Patients with solid tumors were more likely to have had COPD or other pulmonary diseases, have Aspergillus fumigatus infections, and have received radiotherapy before IPA occurrence than were those with haematologic malignancies (all P<0.01). Antifungal monotherapy and voriconazole-based therapy were more often prescribed in the solid group (87% vs 56%, P<0.0001, and 77% vs 53%, P=0.0002, respectively). The median duration of primary antifungal therapy was longer in the solid group (64 days vs 20 days, P<0.0001). Complete or partial response to antifungal therapy was recorded in 66% of the solid group and 40% of the haematologic group (P=0.0001). At 12 weeks, overall mortality was similar in both groups, but IPA-attributable mortality was higher in the haematologic group (30% vs 18%, P=0.04).
CONCLUSIONS: Monotherapy was more often prescribed in patients with solid tumors than patients with haematologic malignancies. Patients with solid tumors had better antifungal therapy response and lower 12-week IPA-attributable mortality than did those with haematologic malignancies.

PMID: 31585141 [PubMed – as supplied by publisher]

Source: Industry