Department of Hematology, Ghent University Hospital, Ghent, Belgium.
Department of Internal Medicine, Section of Infectious Diseases and Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Mycoses. 2024 Mar;67(3):e13715. doi: 10.1111/myc.13715.
Invasive pulmonary aspergillosis (IPA) is a relatively common infection in patients with acute myeloid leukaemia (AML), and is associated with high mortality rates. Optimising early detection is key to reduce the burden of IPA in this population. In this retrospective cohort study, we evaluated the added value of baseline chest CT before start of classical induction chemotherapy.
Adult patients receiving first-line intensive chemotherapy for AML were included if a baseline chest CT scan was available (±7 days). Data were collected from the electronic health record. IPA was classified using the EORTC/MSGERC 2020 consensus definitions.
Between 2015 and 2019, 99 patients were included. During first-line treatment, 29/99 (30%) patients developed a probable IPA. Baseline chest CT was abnormal in 61/99 (62%) and 14/61 (23%) patients had typical radiological signs for IPA. An abnormal scan showed a trend towards higher risk for IPA (hazard ratio (HR): 2.12; 95% CI 0.95-4.84). Ground glass opacities were a strong predictor for developing IPA (HR 3.35: 95% CI 1.61-7.00). No probable/proven IPA was diagnosed at baseline; however, a bronchoalveolar lavage (BAL) at baseline was only performed in seven patients. Twelve-week mortality was higher in patients with IPA (7/26, 27% vs. 5/59, 8%; p = .024).
Baseline chest CT scan could be an asset in the early diagnosis of IPA and contribute to risk estimation for IPA. In patients with an abnormal baseline CT, performing a BAL should be considered more frequently, and not only in patients with radiological findings typical for IPA.
侵袭性肺曲霉病（IPA）是急性髓系白血病（AML）患者中相对常见的感染，与高死亡率相关。优化早期检测对于降低该人群中 IPA 的负担至关重要。在这项回顾性队列研究中，我们评估了在开始经典诱导化疗前基线胸部 CT 的附加价值。
纳入了接受一线强化化疗的 AML 成年患者，如果有基线胸部 CT 扫描（±7 天）。数据从电子健康记录中收集。使用 EORTC/MSGERC 2020 共识定义来分类 IPA。
在 2015 年至 2019 年期间，纳入了 99 名患者。在一线治疗期间，29/99（30%）名患者发生了可能的 IPA。基线胸部 CT 异常的有 61/99（62%）名患者，14/61（23%）名患者有 IPA 的典型影像学征象。异常扫描显示 IPA 风险增加的趋势（风险比（HR）：2.12；95%CI 0.95-4.84）。磨玻璃影是发生 IPA 的强烈预测因子（HR 3.35：95%CI 1.61-7.00）。基线时未诊断出可能/确诊 IPA；然而，仅在 7 名患者中进行了基线支气管肺泡灌洗（BAL）。IPA 患者的 12 周死亡率较高（7/26，27%vs.5/59，8%；p=0.024）。
基线胸部 CT 扫描可能有助于 IPA 的早期诊断，并有助于 IPA 风险评估。在基线 CT 异常的患者中，应更频繁地考虑进行 BAL，而不仅限于影像学表现典型的 IPA 患者。
