12th Congress of the European Hematology ... - Haematologica

12 th Congress of the European Hematology Association
75%, induction for acute leukemia - 50%, consolidation for acute
leukemia - 33%, autologous HSCT - 10%, other treatment for miscellaneous
hematological malignancies - 33%. Summary and conclusions. GM
detection by Platelia Aspergillus kit is very useful for diagnosis of IA in
hematooncological pts. The test has very high sensitivity and especially
very high NPV and so negative test result can exclude IA. The main
problem of the test is false positivities, especially common in group of
hematological pts. with low prevalence of IA. Therefore the regular
screening for GM should be performed only in pts. groups were prevalence
of IA is high - pts undergoing allogeneic HSCT or treatment for
acute leukemia. In low risk group the test should be performed only
when there is clinical suspicion of invasive fungal infection and positive
result should be interpreted very carefully to avoid overtreatment with
expensive new antifungals.
This work was supported by grant of Ministry of Health of the Czech Republic
(IGA NR8452-3/2005).
0209
INCIDENCE OF INVASIVE ASPERGILLOSIS IN ALLOGENEIC STEM CELL
TRANSPLANTATION RECIPIENTS: AN ITALIAN PROSPECTIVE MULTICENTER STUDY
N. Mordini, 1 D. Mattei, 1 B. Bruno, 2 A. Busca, 3 B. Allione, 4 F. Carnevale
Schianca, 5 R. Sorasio, 2 A. Davit, 1 M. Rotta, 2 D. Rapezzi, 1
M. Boccadoro, 2 A. Levis, 4 M. Aglietta, 5 E. Gallo, 3 A. Gallamini1 1 ASO S.Croce e Carle, CUNEO; 2 University of Turin, TURIN; 3 S.Giovanni
Battista Hospital, TURIN; 4 SS. Antonio e Biagio Hospital, ALESSANDRIA;
5 IRCC, CANDIOLO, Italy
Background. So far only retrospective studies have been published
focusing on the incidence of Invasive Aspergillosis (IA) in allogeneic
hematopoietic stem cell transplantation (alloSCT). Patients and Methods.
Between December 2003 and October 2005, 206 patients admitted to
four Piedmont Hematological institutions, on behalf of vita vitae project.
Patients, accounting for 217 alloSCT, were consecutive enrolled in the
trial on the role of combined intensive screening for circulating galactomannan
(GM) and early high resolution chest CT (HRCT) for IA diagnosis.
GM sampling were collected twice in a week from admittance
until day +365; HRCT and/or bronchoscopy with bronco-alveolar lavage
(BAL) were performed when IA was suspected. AlloSCT were performed
for: Multiple Myeloma (61), Lymphoma (39), Acute Leukemia
(64), Myeloprolipherative Disorders (15), Severe Aplastic anemia (2),
solid tumor (14 ) and Chronic Lymphocytic Leukemia (8). Donors were
HLA-Identical siblings (179) or alternative (38). Stem cell source was
peripheral (190), cord blood (2) and bone marrow(15). Conditioning was
myeloablative (104) or Reduced-intensity (113). Previous autologous
SCT was done in 82 patients. One-hundred-fifty-five patients underwent
alloSCT in PR and 72 in CR. Acute and chronic Graft versus Host
Disease (GvHD) affected 157 alloSCTs. Only proven and probable IA,
diagnosed according to the EORTC/MSG criteria were considered for
the analysis of IA incidence. Results. With a follow-up range of 12 to 34
months, 115 patient were alive and 91 had died. Relapse accounted for
57 deaths, transplant related mortality (TRM) for 58, including 10 due
to IA Twenty-five cases of IA were diagnosed: 2 proven and 23 probable.
Six cases were classified as early IA (within day +40 from SCT) and
19 as late IA (beyond day +40 to one year), with an overall incidence of
11,5%. Neutropenia