AN EORTC MULTICENTER PROSPECTIVE SURVEY OF INVASIVE ASPERGILLOSIS IN HEMATOLOGICAL PATIENTS - DIAGNOSIS AND THERAPEUTIC OUTCOME

Objectives: the EORTC Invasive Fungal Infections Cooperative Group (IF ICG) conducted a prospective survey by questionnaire of all cases of i nvasive aspergillosis (IA) in cancer patients to ascertain current dia gnostic and therapeutic approaches. Methods: all members of the IFICG were asked prospectively to complete a detailed questionnaire for each IA case identified in their institution over a 12-month period. Resul ts: one hundred and thirty questionnaires were returned, All cases wer e independently evaluated (DWD & JC) and 123 were eligible. Cases came from 20 hospitals in eight countries and the number of cases per inst itution varied from 1-21, Acute myeloid leukaemia (AML) (60, 49%), acu te lymphoblastic leukaemia (ALL) (21, 17%) and lymphoma (11, 9%) were the most frequent underlying diseases, and 16 (12%) patients had recei ved an allogeneic bone marrow transplant. Pulmonary involvement was pr esent in 87%, infection of sinuses/nose in 16% and brain in 8%. The ch est radiograph was initially normal in 9% of those with primary pulmon ary disease. The diagnosis was confirmed in 50%, probable in 31% and p ossible in 19%, The evidence for IA was on the basis of clinical and r adiological features alone in 28%, with culture or histology in anothe r 31% and 9%, respectively, and with both culture and histology in 29% , In three (2%) patients the diagnosis was based on culture or histolo gy alone. Treatment was given to 120 patients (98%) - amphotericin B 7 5%, lipid-associated amphotericin B 36%, itraconazole 40%, flucytosine 12%, growth factors 33%, lobectomy 5%. At 3 months after diagnosis or first suspicion of IA, 44 (36%) patients were alive and 79 (64%) dead . Outcome was best in those with AML (30% death and 46% with a complet e antifungal response or cure). Growth factors (mostly granulocyte col ony stimulating factor) appeared not to influence outcome (P=0.99). Co nclusion: IA remains a considerable diagnostic and therapeutic challen ge. No single diagnostic procedure was universally successful and a mu ltifaceted approach including surgery is necessary. There was no disce rnable difference in outcome between initial therapy with amphotericin B, itraconazole or lipid-associated amphotericin B, although numbers are limited and the study was retrospective.