Background: Invasive aspergillosis (IA) is a major concern in the hematology ward because of its associated morbidity and mortality. Over time, incidence and mortality rates have been influenced by changing antileukemic therapy, advanced diagnostics, emerging azole resistance and antifungal prophylaxis. We conducted a systematic review of the literature to present a comprehensive overview of current - i.e. 2008-revised EORTC-MSG criteria era - incidence and case fatality rates (CFR) of IA.
Methods: A systematic search in PubMed, Embase and Web of Science was performed in May 2016 to identify relevant studies published between June 2008 and May 2016, reporting the incidence of IA in patient populations with hematologic malignancy. Only studies with a cohort size of >50 adult patients and defining IA according to the updated EORTC/MSG 2008 criteria were eligible for inclusion. Pooled incidence rates using a random effects model were estimated, stratified by patient population and use of antifungal prophylaxis.
Results: The systematic literature search yielded 1285 publications of which 69 met the inclusion criteria. Of 20.052 involved patients, 1387 (pooled proportion in a random effects model 8.2%) were diagnosed with probable or proven IA. Pooled risks in the four subgroups analyzed ranged from 5.1 to 11.7% (figure 1A-D). The pooled case fatality rate within 100 days was 32.5% (95%CI 24.6 40.8%, figure 2).
Conclusion: Pooled incidence rates of IA during remission-induction chemotherapy differed between populations with and without antifungal prophylaxis. Notably, a remaining overall incidence of 5% to 7% was observed in patient populations on mold-active prophylaxis. Reported CFRs were high but showed large variability. The results strongly indicate that factors that cause failure of prophylaxis strategies need further study and improved management.
R. Van De Peppel,
L. Visser, None
M. G. J. De Boer, None
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