BACKGROUND: Voriconazole treatment increases early survival of allogeneic hematopoietic stem cell transplant recipients with invasive aspergillosis. We investigated whether this survival advantage translates into an increased long-term survival. DESIGN AND METHODS: This retrospective study involved all patients with an invasive aspergillosis diagnosis transplanted between September 1997 and December 2008, at the Saint-Louis Hospital, Paris, France. The primary end point was survival up to 36 months. Survival analysis before and after 12 weeks, as well as cumulative incidence analysis in a competing risk framework, were used to assess the effect of voriconazole treatment and other factors on mortality. RESULTS: Among 87 patients, 42 received first-line voriconazole and 45 received another antifungal agent. Median survival time was 2.6 months and survival rate at 36 months was 18%. Overall, there was a significant difference in the survival rates of the two groups. Specifically, there was a dramatic difference in survival rates up to ten months post-aspergillosis diagnosis but no significant difference after this time. Over the first 36 months as a whole, no significant difference in survival rate was observed between the two groups. First-line voriconazole significantly reduced aspergillosis-attributable mortality. However, first-line voriconazole patients experienced a significantly higher probability of death from a non-aspergillosis-attributable cause. CONCLUSIONS: Although the prognosis for invasive aspergillosis after stem cell transplantation has dramatically improved with the use of voriconazole, this major advance in care does not translate into increased long-term survival for these severely immunocompromised patients.
BACKGROUND:Voriconazole treatment increases early survival of allogeneic hematopoietic stem cell transplant recipients with invasive aspergillosis. We investigated whether this survival advantage translates into an increased long-term survival. DESIGN AND METHODS: This retrospective study involved all patients with an invasive aspergillosis diagnosis transplanted between September 1997 and December 2008, at the Saint-Louis Hospital, Paris, France. The primary end point was survival up to 36 months. Survival analysis before and after 12 weeks, as well as cumulative incidence analysis in a competing risk framework, were used to assess the effect of voriconazole treatment and other factors on mortality. RESULTS: Among 87 patients, 42 received first-line voriconazole and 45 received another antifungal agent. Median survival time was 2.6 months and survival rate at 36 months was 18%. Overall, there was a significant difference in the survival rates of the two groups. Specifically, there was a dramatic difference in survival rates up to ten months post-aspergillosis diagnosis but no significant difference after this time. Over the first 36 months as a whole, no significant difference in survival rate was observed between the two groups. First-line voriconazole significantly reduced aspergillosis-attributable mortality. However, first-line voriconazolepatients experienced a significantly higher probability of death from a non-aspergillosis-attributable cause. CONCLUSIONS: Although the prognosis for invasive aspergillosis after stem cell transplantation has dramatically improved with the use of voriconazole, this major advance in care does not translate into increased long-term survival for these severely immunocompromised patients.
Authors: Oliver A Cornely; Johan Maertens; Mark Bresnik; Ramin Ebrahimi; Andrew J Ullmann; Emilio Bouza; Claus Peter Heussel; Olivier Lortholary; Christina Rieger; Angelika Boehme; Mickael Aoun; Heinz-August Horst; Anne Thiebaut; Markus Ruhnke; Dietmar Reichert; Nicola Vianelli; Stefan W Krause; Eduardo Olavarria; Raoul Herbrecht Journal: Clin Infect Dis Date: 2007-04-09 Impact factor: 9.079
Authors: Thomas J Walsh; Elias J Anaissie; David W Denning; Raoul Herbrecht; Dimitrios P Kontoyiannis; Kieren A Marr; Vicki A Morrison; Brahm H Segal; William J Steinbach; David A Stevens; Jo-Anne van Burik; John R Wingard; Thomas F Patterson Journal: Clin Infect Dis Date: 2008-02-01 Impact factor: 9.079
Authors: O Lortholary; J-P Gangneux; K Sitbon; B Lebeau; F de Monbrison; Y Le Strat; B Coignard; F Dromer; S Bretagne Journal: Clin Microbiol Infect Date: 2011-06-10 Impact factor: 8.067
Authors: P Ribaud; C Chastang; J P Latgé; L Baffroy-Lafitte; N Parquet; A Devergie; H Espérou; F Sélimi; V Rocha; H Espérou; F Sélimi; V Rocha; F Derouin; G Socié; E Gluckman Journal: Clin Infect Dis Date: 1999-02 Impact factor: 9.079
Authors: Raoul Herbrecht; David W Denning; Thomas F Patterson; John E Bennett; Reginald E Greene; Jörg-W Oestmann; Winfried V Kern; Kieren A Marr; Patricia Ribaud; Olivier Lortholary; Richard Sylvester; Robert H Rubin; John R Wingard; Paul Stark; Christine Durand; Denis Caillot; Eckhard Thiel; Pranatharthi H Chandrasekar; Michael R Hodges; Haran T Schlamm; Peter F Troke; Ben de Pauw Journal: N Engl J Med Date: 2002-08-08 Impact factor: 91.245
Authors: Ben De Pauw; Thomas J Walsh; J Peter Donnelly; David A Stevens; John E Edwards; Thierry Calandra; Peter G Pappas; Johan Maertens; Olivier Lortholary; Carol A Kauffman; David W Denning; Thomas F Patterson; Georg Maschmeyer; Jacques Bille; William E Dismukes; Raoul Herbrecht; William W Hope; Christopher C Kibbler; Bart Jan Kullberg; Kieren A Marr; Patricia Muñoz; Frank C Odds; John R Perfect; Angela Restrepo; Markus Ruhnke; Brahm H Segal; Jack D Sobel; Tania C Sorrell; Claudio Viscoli; John R Wingard; Theoklis Zaoutis; John E Bennett Journal: Clin Infect Dis Date: 2008-06-15 Impact factor: 9.079