1631. Combination Antifungal Therapy for Invasive Aspergillosis among Patients with Hematopoietic Cell Transplantation and Positive Galactomannan
Session: Poster Abstract Session: Mycology - There's a Fungus Among Us: Treatment
Friday, October 28, 2016
Room: Poster Hall
Posters
  • Hematopoietic Cell Transplantation ID week.pdf (865.8 kB)
  • Background: A recently published post hoc analysis of mortality in invasive aspergillosis (IA), among patients with hematopoietic cell transplantation (HCT) and galactomannan (GM) antigen positivity in serum or bronchoalveolar lavage (BAL) fluid suggested an increase in all-cause mortality with monotherapy compared to combination therapy.

    Methods: We conducted a retrospective cohort study of all adult patients with HCT and positive GM diagnosed with a first episode of proven or probable aspergillosis between 2008–2015 at the Cleveland Clinic. The primary end point was all-cause mortality at 6 weeks. We compared patients treated with combination antifungal therapy to monotherapy.

    Results: We identified 8 patients with HCT and antigen-based diagnosis of aspergillosis. All patients received allogeneic HCT. The incidence of antigen-based diagnosis of IA was 0.6%.  Five (62.5%) underwent HCT for acute myeloid leukemia. Median time to diagnosis of aspergillosis from HCT was 144 days (IQR 46–396). Three (38%) patients had cytomegalovirus viremia within 30 days of diagnosis of IA. Seven (87.5%) were receiving antifungal prophylaxis at the time of presentation: 2 (29%) fluconazole, 4 (57%) itraconazole, and 1 (14%) voriconazole. Aspergillus antibody titers were negative in all patients. Median GM was 3.485 in the combination therapy group and 1.75 among those treated with monotherapy. (Table) Combination antifungal therapy was administered to 3 (37.5%) patients. Two (67%) received voriconazole plus micafungin, and 1 (33%) received posaconazole plus micafungin. One patient on voriconazole-micafungin treatment developed new radiological signs with lack of clinical improvement and hence was changed to amphotericin B with micafungin. All-cause mortality was 20 % in the monotherapy group compared to 67 % in the combination therapy group (P= 0.46).

    Conclusion: Aspergillosis in the current era appears to be uncommon at our institution. In patients with HCT and antigen-based diagnosis of aspergillosis, 6-week mortality was not significantly different in those who received combination therapy compared to monotherapy.

    Table 1.jpg

    Teny Mathew John, MD, Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH and Kyle Brizendine, MD, Infectious Disease, Cleveland Clinic, Cleveland, OH

    Disclosures:

    T. M. John, None

    K. Brizendine, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.