Invasive Pulmonary Aspergillosis in AML and ALL Patients Hospitalized into an Intensive Care Unit Divided into 2 Areas with a Different Specific Air Environment: Evaluation of Posaconazole Prophylaxis and Comparison Between the Two Specific Air Environment Areas

• Published in: Blood 2014-12, Vol.124 (21), p.5260-5260
• Main Authors: Detrait, Marie Y., Morisset, Stephane, Delville, Jean-Pierre, Lixon, Arnaud, Meurisse, Sabine, Holemans, Xavier, De Visscher, Nathalie, Mineur, Philippe, Pranger, Delphine, Nedelcu, Margareta, Depaus, Julien, Di Biase, Martin, Van Wetter, Celine, Anckaert, Francoise, Kornreich, Anne, Canon, Jean-Luc
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V124.21.5260.5260

Background Invasive aspergillosis (IA) during induction chemotherapy of acute leukemia or allogeneic HSCT has a negative impact on the outcome of patients and is a major concern in haematology department. The impact of air treatment on invasive aspergillosis since the introduction of posaconazole prophylaxis is not very well studied at this time. In our center, the haematological intensive care unit contain ten single rooms each, of which 4 rooms are equipped with laminar airflow named “Controlled Air Zone” (CAZ) and 6 rooms have no specific air treatment (NSAT). Objective Our objective in this study was to compare the development of IA during hospitalization in the two areas of the unit and to analyze the impact of posaconazole prophylaxis on the short- and long-term survival. We compared the outcome of 56 consecutive patients hospitalized for induction treatment of ALL, AML or underwent allogeneic HSCT for AML/ALL in CR1 or had been hospitalized for GvHD treatment between the years 2009 and 2013. Posaconazole prophylaxis was introduced in 2013. Results In this study, there were 29 (52%) male and 27 (48%) female with a median age of 53 years (range, 20-64), diagnosis were AML for 35 (62.5%) patients, ALL for 11 (19.65%) patients, allogeneic HSCT for 4 (7.14%) patients (AML in CR1 for 3 and ALL in CR1 for 1), episode of aGvHD for 4 (7.14) patients and biphenotypic AL for 2 (3.57%) patients. All patients with GvHD had a grade III-IV of acute GvHD with digestive involvement. Fourty (71%) patients were hospitalized in the CAZ and 16 (29%) patients in the NSAT zone. Eleven (19%) patients received posaconazole and 45 (81%) patients received fluconazole (p=0.007). IA was observed in 19 (34%) patients: 12 (21%) patients in the CAZ and 7 (12%) patients in the NSAT zone with a median time of 2.7 months (range, 0.3-20.50) since disease diagnosis. Twenty-five (44.6%) patients died in this study: 21(37.5%) from relapse and 4 (7%) from aspergillosis. After a median follow-up of 12.23 months (range, 0.4-54), the probability of survival at 6 months and 12 months was for patients in CAZ: 72.5% and 64.44% respectively and for patients not in CAZ: 67.71% and 54.17% respectively. The probability of survival at 6 months and 12 months for posaconazole patients was 90% for both, and for fluconazole patients: 66.67% and 54.17% respectively. The survival according to treatment and zone is presented in Figure 1. The cumulative incidence of aspergillosis at 6, 12 and 24 months for