Hematology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, 5 Place d'Arsonval, 69437, Lyon Cedex 03, France.
Eur J Clin Microbiol Infect Dis. 2012 Jun;31(6):991-7. doi: 10.1007/s10096-011-1397-5. Epub 2011 Sep 10.
Invasive aspergillosis (IA) during induction chemotherapy of acute myeloid leukemia (AML) could worsen the prognosis. Our objective was to study how the development of IA during AML interferes with the therapeutic strategy and to evaluate its impact on the short- and long-term survival. Newly diagnosed AML patients between the years 2004 and 2007 were retrospectively analyzed. The outcome was death of the patient. A Cox proportional hazards model with the diagnosis of IA and post-induction response evaluation as the main exposure was fitted. Overall, 262 patients were analyzed and 58 IA were observed. The 2-year survival of patients having had remission of AML was 54% and, for patients with failure of chemotherapy, it was 5% (p < 0.001). The 2-year survival of patients having had IA was 14%, and without IA, it was 32% (p = 0.01). Multivariate analysis showed that IA was associated with a higher risk of death in case of remission compared to no IA (hazard ratio [HR] = 1.66 [1.05-2.65], p = 0.031) and also in case of failure (HR = 6.43, p < 0.001). IA was associated with an increased risk of death for patients if they were either in remission or in failure after induction chemotherapy.
急性髓细胞白血病（AML）诱导化疗期间的侵袭性曲霉病（IA）可能会使预后恶化。我们的目的是研究 IA 在 AML 中的发展如何干扰治疗策略，并评估其对短期和长期生存的影响。对 2004 年至 2007 年间确诊的 AML 患者进行回顾性分析。结局为患者死亡。采用 Cox 比例风险模型，以 IA 诊断和诱导后反应评估为主要暴露因素进行拟合。共分析了 262 例患者，观察到 58 例 IA。AML 缓解患者的 2 年生存率为 54%，化疗失败患者的 2 年生存率为 5%（p<0.001）。IA 患者的 2 年生存率为 14%，无 IA 患者的 2 年生存率为 32%（p=0.01）。多变量分析显示，与无 IA 相比，IA 与缓解患者死亡风险增加相关（危险比[HR]=1.66[1.05-2.65]，p=0.031），与化疗失败患者死亡风险增加相关（HR=6.43，p<0.001）。IA 与诱导化疗后缓解或失败的患者死亡风险增加相关。
