Background

Invasive pulmonary aspergillosis (IPA) is commonly associated with haematologic malignancies but also occurs with solid tumors.

Aim

Comparing the diagnostic approaches and therapeutic outcomes for IPA between patients with haematologic malignancies and solid cancers.

Methods

We conducted a retrospective study evaluating consecutive cases of proven and probable IPA from 2004 to 2016. We included patients >18 years old with an underlying solid tumor, haematologic malignancy, or haematopoietic cell transplantation (HCT) within 1 year of IPA diagnosis.

Findings

Of the 311 patients analyzed, 225 had haematologic malignancies and 86 had solid tumors. Patients with solid tumors were more likely to have had COPD or other pulmonary diseases, have Aspergillus fumigatus infections, and have received radiotherapy before IPA occurrence than were those with haematologic malignancies (all P<0.01). Antifungal monotherapy and voriconazole-based therapy were more often prescribed in the solid group (87% vs 56%, P<0.0001, and 77% vs 53%, P=0.0002, respectively). The median duration of primary antifungal therapy was longer in the solid group (64 days vs 20 days, P<0.0001). Complete or partial response to antifungal therapy was recorded in 66% of the solid group and 40% of the haematologic group (P=0.0001). At 12 weeks, overall mortality was similar in both groups, but IPA-attributable mortality was higher in the haematologic group (30% vs 18%, P=0.04).

Conclusions

Monotherapy was more often prescribed in patients with solid tumors than patients with haematologic malignancies. Patients with solid tumors had better antifungal therapy response and lower 12-week IPA-attributable mortality than did those with haematologic malignancies.

中文翻译：

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侵袭性肺曲霉病：潜在血液系统恶性肿瘤与实体瘤的癌症患者的比较分析

背景

侵袭性肺曲霉病（IPA）通常与血液系统恶性肿瘤有关，但也与实体瘤有关。

目的

比较血液系统恶性肿瘤和实体癌患者IPA的诊断方法和治疗效果。

方法

我们进行了一项回顾性研究，评估了2004年至2016年连续的IPA确诊和可能病例。我们纳入了IPA诊断后1年以内的实体瘤，血液系统恶性肿瘤或造血细胞移植（HCT）大于18岁的患者。

发现

在所分析的311例患者中，225例患有血液系统恶性肿瘤，86例患有实体瘤。实体瘤患者更有可能患有COPD或其他肺部疾病，烟曲霉感染，并且在发生IPA之前接受过放疗的比例高于血液系统恶性肿瘤（所有P <0.01）。固体组中更常使用抗真菌单一疗法和伏立康唑为基础的疗法（分别为87％vs 56％，P <0.0001，77％vs 53％，P = 0.0002）。固体组初次抗真菌治疗的中位时间较长（64天vs 20天，P <0.0001）。66％的固体组和40％的血液学组记录了对真菌治疗的全部或部分反应（P = 0.0001）。在12周时，两组的总死亡率相似，但血液学组的IPA归因死亡率更高（30％比18％，P = 0.04）。

结论

在实体瘤患者中比在血液系统恶性肿瘤患者中更常开单药治疗。与血液系统恶性肿瘤患者相比，实体瘤患者具有更好的抗真菌治疗反应，并降低了12周IPA归因的死亡率。