PROGNOSTIC FACTORS OF INVASIVE PULMONARY ASPERGILLOSIS IN LEUKEMIC PATIENTS

The study objective was to identify prognostic factors associated with survival in patients treated for acute leukemias who developed invasi ve aspergillosis (IA) during induction therapy. This retrospective ana lysis involved 21 patients treated in two hematologic centers over a s ix-year period. All were treated in protective isolated rooms with hig h-dose amphotericin B as soon as fungal infection was suspected. Ten ( 45%) of the twenty-one patients died. There was no statistical differe nce between the patients who survived and those who died in relation t o the mean time of onset of IA or the total and mean daily dose of amp hotericin B. On the other hand a favourable outcome correlated strongl y with complete leukemic remission (p < 0.0001): all but one of the pa tients with objective residual leukemia died of IA, whereas all those who achieved complete hematological remission survived. In conclusion, it seems that the main vital prognostic factor in these leukemic pati ents with IA was the achievement of complete remission. We were unable to control IA in 10 of 11 patients with refractory leukemia, regardle ss of neutropenic status, despite early administration of high-dose am photericin B. All the patients who achieved complete remission were su ccessfully treated with amphotericin B.