T. Yeghen et al., Management of invasive pulmonary aspergillosis in hematology patients: A review of 87 consecutive cases at a single institution, CLIN INF D, 31(4), 2000, pp. 859-868
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.