INVASIVE PULMONARY ASPERGILLOSIS PRIOR TO BMT IN ACUTE-LEUKEMIA PATIENTS DOES NOT PREDICT A POOR OUTCOME

Eight patients with acute leukemia (AL) and invasive pulmonary aspergi llosis (IPA) developing during previous antileukemic therapy underwent BMT (autologous in 6 cases and allogeneic 2). IPA was treated prior t o BMT with full doses of amphotericin B, associated with surgical rese ction in three cases. One patient was treated with amphotericin B and itraconazole. Prior to BMT, seven patients had minimal residual pulmon ary lesions. All patients received amphotericin B (0.5 mg/kg/day) duri ng the aplastic period prior to engraftment. One patient died of Gram- negative septic shock before engraftment. Seven patients achieved comp lete hematological engraftment without any evidence of IPA reactivatio n. Amphotericin B was well tolerated with only minimal transient renal dysfunction in three patients. Later pulmonary complications related to IPA were observed in only one patient who developed a self-limited episode of hemoptysis. One patient died of CMV pneumonitis and two of leukemia relapse. Four patients survive disease-free and without compl ications related to IPA. We conclude that the reactivation of correctl y treated IPA can be successfully prevented in BMT patients by use of prophylactic amphotericin B. With this approach, prior IPA is not a co ntraindication to BMT.