AUTOLOGOUS BONE-MARROW TRANSPLANTATION IS FEASIBLE IN PATIENTS WITH APRIOR HISTORY OF INVASIVE PULMONARY ASPERGILLOSIS

We report on seven adult leukemic patients who were autografted in spi te of a prior history of invasive pulmonary aspergillosis (IPA), Their median age was 41 years (range: 19-61); six patients were male and on e female, All seven had acute myeloblastic leukemia (AML) and underwen t an autologous marrow transplantation (AML) with a marrow purged in v itro by mafosfamide, IPA was suspected prior to ABMT on clinical and r adiological features, CT scan confirmed nodular infiltrates and cavita tions in six cases, Microbiological documentation consisted of: identi fication of the fungus from bronchoalveolar lavage: one case, positive antigenemia: one case, positive antibodies: two cases. Prior ABMT pat ients received amphotericin B for a median total dose of 1915 mg (rang e: 970-3300), No patient underwent surgery, The median time from diagn osis of IPA to ABMT was 7.3 months (range: 3-10), During ABMT all pati ents received prophylactic amphotericin B and itraconazole, No patient died from toxicity and no IPA reactivation was observed in any patien ts, Post-graft, itraconazole was kept on for a median of 3 months (ran ge: 3-5), This study demonstrates that IPA occurring during the manage ment of AML patients is not necessarily a contraindication to subseque nt ABMT.