413. Outcome Analysis of Invasive Aspergillosis (IA) in Hematologic Malignancy Patients (HMP) Receiving Salvage Antifungal Therapy: The Role of Novel Azoles
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: IA remains as a major cause of morbidity and mortality in HMP. Different prognostic factors have been described focusing on hematopoietic stem cell transplant (HSCT) patients not other HMP. We evaluated the prognostic factors for IA outcomes among HMP with and without HSCT receiving salvage therapy.
Methods: Between August 1993 and June 2008 we conducted a retrospective review of 315 HMP with proven or probable IA (according to EORTC/MSG criteria who required salvage therapy. HSCT was considered if it occurred in the year prior to onset of IA or during IA treatment.
Results: The mean age was 52 years (range 7-83), only 37% had HTSC, 74% failed to response to therapy and 54% had IA attributed death. By multivariate logistic regression analysis, persistent neutropenia for more than 2 weeks during IA (OR 0.3, 95% CI: 0.1 to 0.6, p<0.001), intensive care unit stay (ICU) during IA (OR 0.3, 95% CI: 0.05 to 0.2, p< 0.0001) and graft versus host disease (OR 0.3, 95% CI: 0.1 to 0.6, p=0.001) were independently associated with failure to therapy. In contrast, myeloma (OR 5.3, 95% CI: 1.3 to 21.5, p=0.018) and primary therapy containing azoles (posaconazole or voriconazole) (OR 3.2, 95% CI: 1.6 to 6.4, p=0.002) were associated with favorable response to therapy. ICU stay (OR 4.9, 95% CI: 3.0 to 8.0, p<0.0001) was independently associated with IA attributable death, however primary therapy containing azoles was protective (OR 0.5, 95% CI: 0.3 to 0.9, p=0.024).
Conclusion: Early initiation of novel azoles (voriconazole and posaconazole) therapy improves the overall outcome of IA in HMP, including attributable death.
Ray Hachem, MD1, Ying Jiang, MS2, Christelle Kassis, MD2, Issam Raad, MD, Elizabeth Ramos, MD2 and  E. R. Ramos, None..
C. Kassis, None..
R. Hachem, None..
Y. Jiang, None. 
I. I. Raad,
Cook, Inc. Role(s): Consultant, Research Relationship, Other, Royalties related to technology on which Dr. Raad is an inventor/co-inventor, Consultant, Research Relationship, Other, Royalties related to technology on which Dr. Raad is an inventor/co-inventor, Consultant, Research Relationship, Other, Royalties related to technology on which Dr. Raad is an inventor/co-inventor, Received: Educational Grant, Licensing Agreement or Royalty, Consulting Fee., (1)Infectious Diseases, Infection Control & Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX, (2)University of Texas, M.D. Anderson Cancer Center, Houston, TX

Disclosures:

R. Hachem, None

Y. Jiang, None

C. Kassis, None

I. Raad, None

E. Ramos, None