Autologous peripheral blood stem cell transplant in patients previously diagnosed with invasive aspergillosis

Patients previously diagnosed with invasive aspergillosis (IA) have been co nsidered to be at risk for relapse of mycosis during subsequent hematopoiet ic transplant. Even with prophylactic measures, reactivation of the infecti on occurs in 29% of patients undergoing bone marrow transplantation (BMT). A period of neutropenia is one of the variables considered to be a risk fac tor for reactivation. Peripheral blood stem cell transplant (PBSCT) results in a shorter neutropenia period leading to a lower risk of fungal infectio n. A retrospective data analysis performed on patients undergoing autologou s PBSCT for hematological malignancies in our unit showed that nine patient s were diagnosed before transplantation with IA. All patients received only medical treatment during their primary infection. Medical prophylaxis was administered in seven of these patients, and two underwent transplantation without prophylaxis. All patients developed severe neutropenia after a myel oablative regimen. All but one had neutropenic fever, although the fever wa s controlled and no fungal complications occurred. All patients in this ser ies achieved complete hematological engraftment without delay in granulocyt e recovery (mean: 8.78 vs 9.76; p = 0.58). No significant differences were observed in toxicities with regards to transplantation between patients pre viously diagnosed with IA and their controls. Recurrence of IA related to t ransplantation was avoided since no relapse of IA was demonstrated. This se ries of nine patients with a previous history of IA shows that medical trea tment, secondary prophylaxis, and peripheral blood as a source of stem cell s could be effective measures to avoid reactivation of previous aspergillos is during hematopoietic transplantation, although prospective randomized tr ials should still be performed to confirm these findings in a wider setting .