invasive aspergillosis in patients with acute myeloid leukemia: SEIFEM-2008 registry study.

Background This study evaluated prognostic factors, treatments and outcome of invasive aspergillosis (IA) in patients with acute myeloid leukemia (AML). DESIGN AND METHODS: The registry, which was activated in 2004 and closed in 2007, collected data on AML patients admitted to 21 hematological divisions in tertiary care centres or university hospitals in Italy, who developed proven or probable IA. RESULTS: 140 cases of IA were collected, with most cases occurring in post-induction aplasia, the highest risk phase in AML. IA-attributable mortality rate was 27%, confirming previous reports of a downward trend. Univariate and multivariate analyses revealed AML stage, duration of, and recovery from, neutropenia as independent prognostic factors. We analyzed outcomes after treatment with the three most frequently used drugs (liposomal amphotericin B, caspofungin, voriconazole). No differences emerged in survival on the 120th day or in the overall response rate which was 71%, ranging from 61% with caspofungin to 84% with voriconazole. Conclusions Our series confirms the downward trend in mortality rates reported in previous series, with all new drugs providing similar survival and response rates. Recovery from neutropenia and disease stage are crucial prognostic factors. Efficacious antifungal drugs bridge the gap due to poor hematological and immunological reconstitution.