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Background <p>Despite important advancements in diagnostic modalities, routine use of therapeutic drug monitoring (TDM) and newer antifungal therapies, there is a paucity of contemporary data regarding clinical characteristics and outcomes of invasive aspergillosis (IA) in the United States.</p> Methods <p>Single-center, retrospective cohort study of hospitalized patients between 2015 and 2020, who had active hematological malignancy (HM) or had undergone transplantation and cellular therapy (TCT) and had probable&#xa0;or&#xa0;proven IA.</p> Results <p>Sixty-two patients with probable&#xa0;or&#xa0;proven IA, including 21 HM and 41 TCT, were identified. Forty-four percent of the cases corresponded to breakthrough IA. Bronchoalveolar lavage galactomannan was ≥ 1 in 71% and ≥ 0.5 in 88%, while serum galactomannan was ≥ 0.5 in only 34%. Among assessable patients (n = 59), 90-day partial or complete response to antifungal therapy occurred in 39%. All-cause mortality for the entire cohort was 22% at 30&#xa0;days and 46% at 90&#xa0;days. IA attributable mortality was 18% at 30&#xa0;days and 38% at 90&#xa0;days. Achieving therapeutic antifungal serum levels was associated with a reduction in all-cause mortality, while prior clinically significant CMV infection (aOR 9.65, 95% CI 1.34–69.6; <i>P</i> = 0.025) and relapsed/refractory hematological disease (aOR 8.5, 95% CI 2.23, 32.4; <i>P</i> = 0.002) were associated with higher IA attributable mortality.</p> Conclusions <p>Despite advancements in diagnosis and treatment, IA remains associated with poor outcomes in hematological patients in the contemporary era. Newer antifungals and improved strategies for monitoring and prevention of IA in these vulnerable patient populations are urgently needed.</p>

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Clinical Characteristics and Outcomes of Invasive Aspergillosis in Patients with Hematological Malignancies and Transplantation and Cellular Therapies in the Contemporary Era

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月5日

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  • Christopher M. Lopez,
  • Jose F. Suarez,
  • Maria A. Mendoza,
  • Anthony D. Anderson,
  • Jill Lykon,
  • Wenhui Li,
  • Michele I. Morris,
  • Yoichiro Natori,
  • Mohammed Raja,
  • Lazaros J. Lekakis,
  • Amer Beitinjaneh,
  • Antonio Jimenez,
  • Mark Goodman,
  • Trent P. Wang,
  • Jay Spiegel,
  • Noa G. Holtzman,
  • Denise Pereira,
  • Damian Green,
  • Krishna V. Komanduri,
  • Jose F. Camargo

摘要

Background

Despite important advancements in diagnostic modalities, routine use of therapeutic drug monitoring (TDM) and newer antifungal therapies, there is a paucity of contemporary data regarding clinical characteristics and outcomes of invasive aspergillosis (IA) in the United States.

Methods

Single-center, retrospective cohort study of hospitalized patients between 2015 and 2020, who had active hematological malignancy (HM) or had undergone transplantation and cellular therapy (TCT) and had probable or proven IA.

Results

Sixty-two patients with probable or proven IA, including 21 HM and 41 TCT, were identified. Forty-four percent of the cases corresponded to breakthrough IA. Bronchoalveolar lavage galactomannan was ≥ 1 in 71% and ≥ 0.5 in 88%, while serum galactomannan was ≥ 0.5 in only 34%. Among assessable patients (n = 59), 90-day partial or complete response to antifungal therapy occurred in 39%. All-cause mortality for the entire cohort was 22% at 30 days and 46% at 90 days. IA attributable mortality was 18% at 30 days and 38% at 90 days. Achieving therapeutic antifungal serum levels was associated with a reduction in all-cause mortality, while prior clinically significant CMV infection (aOR 9.65, 95% CI 1.34–69.6; P = 0.025) and relapsed/refractory hematological disease (aOR 8.5, 95% CI 2.23, 32.4; P = 0.002) were associated with higher IA attributable mortality.

Conclusions

Despite advancements in diagnosis and treatment, IA remains associated with poor outcomes in hematological patients in the contemporary era. Newer antifungals and improved strategies for monitoring and prevention of IA in these vulnerable patient populations are urgently needed.