Is ASCT a reasonable option in patients with invasive aspergillosis?

Most patients with leukaemia and invasive aspergillosis (IA) undergoing allogeneic stem cell transplantation (ASCT) will benefit from this procedure. This was the main conclusion from a prospective study of the EBMT Infectious Diseases Working Party (IDWP). Thus, IA should not be considered an absolute contraindication for ASCT, according to the authors.

“IA is common during the treatment of acute leukaemia,” said Prof. Olaf Penack (Charité University Hospital of Berlin, Germany) [1]. “Since anti-fungal management has improved in recent years, it is interesting to examine the influence of IA on health outcomes in a recent cohort of patients with acute leukaemia and IA undergoing ASCT.” The current prospective study included 1,527 participants. The primary outcome was the 1-year non-relapse mortality.

The incidence of IA was 6.2% (n=95). A multivariate analysis demonstrated that the cumulative incidence of non-relapse mortality at 1-year post-ASCT was 16.9% in participants with IA and 11.4% in participants without IA (HR 1.9; 95% CI 1.12–3.28; P=0.02). Corresponding HRs for relapse-free survival and 1-year overall survival were 1.54 and 1.70, favouring the non-IA group over the IA group significantly.

“In total, 67% of patients with IA and 79% of patients without IA were alive at 1-year post-ASCT, displaying that IA is still a significant risk factor,” interpreted Prof. Penack the findings. “More importantly, patients with IA have a high chance of surviving ASCT. Therefore, IA should no longer be considered as an absolute contraindication for ASCT,” he concluded.

1. Penack O, et al. Influence of invasive aspergillosis during leukaemia treatment on survival after allogeneic stem cell transplantation: a prospective study of the EBMT infectious diseases working party. OS08-01, European Society for Blood and Marrow Transplantation (EBMT) 49^th Annual Meeting, 23–26 April 2023, Paris, France.

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Posted on 14 June 202315 February 2024