Management of invasive pulmonary aspergillosis in hematology patients: A review of 87 consecutive cases at a single institution

Eighty-seven patients with hematologic malignancies and invasive pulmonary aspergillosis (IPA) were identified between 1982 and 1995. Of these, 39 und erwent lung resection on the basis of radiological detection of at least 1 lesion with imaging suggestive of aspergillosis (LISA). IPA was confirmed h istologically in 35. The presence of LISA had 90% positive predictive value for IPA. The actuarial survival at 2 years was 36% for 37 patients treated surgically, 20% for 12 patients with unresected LISA but no cultures of As pergillus species, and 5% for 21 patients diagnosed only by isolation of As pergillus from respiratory secretions. Analysis by proportional hazard mode ls showed a significant independent negative association between the radiol ogical appearance of LISA and death from all causes. Relapsed hematologic d isease was independently significantly associated with death. Age, sex, sur gery, previous bone marrow transplantation, or Aspergillus isolation were n ot independent predictors of death. IPA presenting as LISA carries a relati vely good prognosis, possibly explaining the better survival of patients un dergoing surgery for such lesions.