Persistent poor long-term prognosis of allogeneic hematopoietic stem cell transplant recipients surviving invasive aspergillosis
| Autor: | Patricia Ribaud, Anna D. Petropoulou, Annie Sulahian, Régis Peffault de Latour, Raphaël Porcher, Marie Robin, Anne Bergeron, Géraldine Salmeron, Vanderson Rocha, Aliénor Xhaard, Gérard Socié, Claire Lacroix, Christèle Ferry |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male medicine.medical_specialty Antifungal Agents Time Factors Adolescent medicine.medical_treatment Hematopoietic stem cell transplantation Aspergillosis Immunocompromised Host Young Adult Cause of Death Internal medicine medicine Humans Cumulative incidence Child Survival rate Survival analysis Retrospective Studies Cause of death Voriconazole business.industry Hematopoietic Stem Cell Transplantation Hematology Middle Aged Prognosis medicine.disease Surgery Survival Rate Transplantation Aspergillus Child Preschool Hematologic Neoplasms Female Original Articles and Brief Reports business Follow-Up Studies medicine.drug |
| Zdroj: | Haematologica. 97:1357-1363 |
| ISSN: | 1592-8721 0390-6078 |
| DOI: | 10.3324/haematol.2011.058255 |
| Popis: | Background Voriconazole treatment increases early survival of allogeneic hematopoietic stem cell transplant recipients with invasive aspergillosis. We investigated whether this survival advantage translates into an increased long-term survival. Design and Methods This retrospective study involved all patients with an invasive aspergillosis diagnosis transplanted between September 1997 and December 2008, at the Saint-Louis Hospital, Paris, France. The primary end point was survival up to 36 months. Survival analysis before and after 12 weeks, as well as cumulative incidence analysis in a competing risk framework, were used to assess the effect of voriconazole treatment and other factors on mortality. Results Among 87 patients, 42 received first-line voriconazole and 45 received another antifungal agent. Median survival time was 2.6 months and survival rate at 36 months was 18%. Overall, there was a significant difference in the survival rates of the two groups. Specifically, there was a dramatic difference in survival rates up to ten months post-aspergillosis diagnosis but no significant difference after this time. Over the first 36 months as a whole, no significant difference in survival rate was observed between the two groups. First-line voriconazole significantly reduced aspergillosis-attributable mortality. However, first-line voriconazole patients experienced a significantly higher probability of death from a non-aspergillosis-attributable cause. Conclusions Although the prognosis for invasive aspergillosis after stem cell transplantation has dramatically improved with the use of voriconazole, this major advance in care does not translate into increased long-term survival for these severely immunocompromised patients. |
| Databáze: | OpenAIRE |
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