1588. Invasive aspergillosis in patients with Hodgkin’s lymphoma and acute lymphoblastic leukemia in Saint-Petersburg, Russia
Session: Poster Abstract Session: Mycology - There's a Fungus Among Us: Epidemiology
Friday, October 28, 2016
Room: Poster Hall
Background: Invasive aspergillosis (IA) often occurs in hematological patients with immunodeficiency after cytostatic therapy or HSCT.

Methods: We examined 37 adult patients with HL, the median age – 32 years, males – 49%. The control group: 32 adult patients with IA and acute lymphoblastic leukemia (ALL), median age – 39 years, males – 75%. For the diagnosis of IA were used criteria EORTS/MSG 2008.

Results:

In all patients IA developed after cytostatic therapy, the average number of courses – 2 vs 6 (p=0,0002). Prolonged neutropenia was in 59% vs 81% patients (p=0,01), lymphocytopenia – 64% vs 62%, steroids were used in 70% vs 68% patients, bacterial infections were detected in 19% vs 22% patients, viral infections – 11% vs 9%.

The main sites of infection were lungs – 100% and 94%, disseminated IA in 2% vs 12% patients (p=0,0001), CNS involvement - 2% vs 6% (p=0,03).

In HL group 100% of patients had probable IA, in ALL group probable – 88%, proven – 12% (p=0,02). Galactomannan test was positive in 72% vs 75%. Direct microscopy of BAL was positive - 14% vs 28% cases, Aspergillus spp. were isolated in culture in 32% vs 34%. The main etiological agents: A.fumigatus - 58% vs 55%, A.niger – 34% vs 27%, A.flavus – 8% vs 18%.

Patients in both groups received antifungal therapy: voriconazole – 55% vs 58%, caspofungin – 21% vs 18%, amphotericin B deoxycholate – 12% vs 9%, posaconazole – 8% vs 6%, and itraconazole – 4% vs 9%.

Overall survival rate in 12-weeks was 89% vs 81%. Secondary antifungal prophylaxis was used in 24% vs 32% patients. In 1 year follow up period complete remission of IA occurred in 77% vs 44% patients (р=0,01).

Negative prognostic factors of 12th week survival were bacterial or viral infections (p=0,04), positive prognostic factor of 1 year survival was secondary antifungal prophylaxis (p=0,02).

Conclusion: The main risk factors of IA development in patients with HL were lymphocytopenia and corticosteroids using. The main etiological agents: A.fumigatus - 58% and A.niger – 34%. All patients had IA with lung involvement, dissemination and CNS involvement were rare. 12th week overall survival was 89%. Positive prognostic factors of 1 year survival was secondary antifungal prophylaxis, negative prognostic factors of 12th week survival - bacterial or viral infections.

Nikolay Klimko, D.Sc., Professor1, Olga Shadrivova, PHD1, Ekaterina Desyatik, mycologist2, Yuliya Borzova, PhD2, Svetlana Ignatyeva, PHD2, Tatyana Bogomolova, PhD2, Alisa Volkova, pulmonologist3, Ludmila Zubarovskaya, PHD, professor3, Boris Afanasyev, PhD, Professor4 and Natalya Vasilyeva, D.Sc., Professor2, (1)Department of Clinical Mycology, Allergy and Immunology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russian Federation, (2)North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russian Federation, (3)R. Gorbacheva Institute of Children’s Hematology and Transplantology, St. Petersburg, Russian Federation, (4)2 R. Gorbacheva Institute of Children’s Hematology and Transplantology, St. Petersburg, Russian Federation

Disclosures:

N. Klimko, None

O. Shadrivova, None

E. Desyatik, None

Y. Borzova, None

S. Ignatyeva, None

T. Bogomolova, None

A. Volkova, None

L. Zubarovskaya, None

B. Afanasyev, None

N. Vasilyeva, None

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