Program Schedule

1463
Immune Reconstitution Inflammatory Syndrome (IRIS) in Neutropenic Patients with Invasive Pulmonary Aspergillosis (IPA) during Neutrophil Recovery

Session: Poster Abstract Session: Fungal Infections
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Limited data on the incidence and clinical characteristics of IRIS in neutropenic patients with IPA were available.

Methods: During 6-year period, adult patients with neutropenia who met probable or proven IPA by the EORTC criteria were retrospectively enrolled. IRIS was defined as new appearance or worsening of radiologic pulmonary findings temporally related to neutrophil recovery with evidence of a decrease 50% in serum galactomannan index titers.

Results: Of 150 patients, 35 (23%, 95% CI 17% - 31%) developed IRIS during neutrophil recovery. IRIS was associated with shorter neutropenic period, controlled underlying hematologic disease, less immunosuppressant use, and voriconazole use (Table 1). The 30- and 90-day mortalities were lower in patients with IRIS than those with non- IRIS (Table 1). In the subgroup analysis of 53 patients who had progressive disease during the neutrophil recovery, 35 (66%, 95% CI 53% -77%) were classified as IRIS group. The 30- and 90-day mortalities was higher in patients with non-IRIS who had progressive disease during the neutrophil recovery than in those with IRIS (9% vs 39%, P=0.02 and 31% vs 72%, P=0.005, respectively).

Conclusion: IRIS occured in about one quarter of neutropenic patients with IPA, was associated with voriconazole use. In addition, it appears to be a good prognostic factor.

Table 1.Clinical characteristics and outcomes of neutropenic patients with and without immune reconstitution inflammatory syndrome following initiation of antifungal therapy for invasvie pulmonary aspergillosis

 

IRIS

(n=35)

Non-IRIS

 (n=115)

P

Age, median years (IQR)

55 (46-64)

52 (41-61)

0.39

Male gender

24 (68.6)

70 (60.9)

0.41

Underlying disease/conditions

 

 

 

Acute leukemia

28 (80)

87 (76)

0.59

Aplastic anemia

1 (3)

12 (10)

0.30

Lymphoma

2 (6)

8 (7)

>0.99

Receipt of HCT

9 (26)

42 (35)

0.24

Prior corticosteroid use

7 (20)

39 (34)

0.12

Prior immunosuppressant use

3 (9)

30 (26)

0.03

Controlled state of underlying disease

11 (31)

18 (16)

0.04

Length of neutropenic period, median days (IQR)

29 (19-50)

40 (23-87)

0.04

Peak galactomannan index, median value (IQR)

1.4 (0.7-3.4)

1.5 (0.7-3.6)

0.86

Antifungal therapy on diagnosis day of IPA

 

 

 

Amphotericin B

17 (49)

69 (60)

0.23

Voriconazole

15 (43)

29 (25)

0.045

Outcome after diagnosis of IPA

 

 

 

30-day mortality

3 (9)

38 (33)

0.004

90-day mortality

11 (31)

67 (58)

0.005

Jiwon Jung, MD, Sun In Hong, MD, Shinae Yu, MD, Yong Kyun Kim, MD, Ju-Young Lee, MD, Sang-Oh Lee, MD, Sang-Ho Choi, MD, Yang Soo Kim, MD, Jun Hee Woo, MD and Sung-Han Kim, MD, Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

Disclosures:

J. Jung, None

S. I. Hong, None

S. Yu, None

Y. K. Kim, None

J. Y. Lee, None

S. O. Lee, None

S. H. Choi, None

Y. S. Kim, None

J. H. Woo, None

S. H. Kim, None

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