1Assistance Publique-Hôpitaux de Paris, Service d’Hématologie-Greffe, Hôpital Saint-Louis, Paris
Raphaël Porcher
2Assistance Publique-Hôpitaux de Paris, Département de Biostatistiques, Hôpital Saint-Louis, Paris;3Université Paris-Diderot, Sorbonne Paris, Cité, Paris
Anne Bergeron
3Université Paris-Diderot, Sorbonne Paris, Cité, Paris;4Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Hôpital Saint-Louis, Paris
Marie Robin
1Assistance Publique-Hôpitaux de Paris, Service d’Hématologie-Greffe, Hôpital Saint-Louis, Paris
Régis Peffault de Latour
1Assistance Publique-Hôpitaux de Paris, Service d’Hématologie-Greffe, Hôpital Saint-Louis, Paris;3Université Paris-Diderot, Sorbonne Paris, Cité, Paris
Christèle Ferry
1Assistance Publique-Hôpitaux de Paris, Service d’Hématologie-Greffe, Hôpital Saint-Louis, Paris
Vanderson Rocha
1Assistance Publique-Hôpitaux de Paris, Service d’Hématologie-Greffe, Hôpital Saint-Louis, Paris
Anna Petropoulou
1Assistance Publique-Hôpitaux de Paris, Service d’Hématologie-Greffe, Hôpital Saint-Louis, Paris
Aliénor Xhaard
1Assistance Publique-Hôpitaux de Paris, Service d’Hématologie-Greffe, Hôpital Saint-Louis, Paris;3Université Paris-Diderot, Sorbonne Paris, Cité, Paris
Claire Lacroix
4Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Hôpital Saint-Louis, Paris;5Assistance Publique-Hôpitaux de Paris, Service de Mycologie-Parasitologie, Hôpital Saint-Louis, Paris, France
Annie Sulahian
4Assistance Publique-Hôpitaux de Paris, Service de Pneumologie, Hôpital Saint-Louis, Paris;5Assistance Publique-Hôpitaux de Paris, Service de Mycologie-Parasitologie, Hôpital Saint-Louis, Paris, France
Gérard Socié
1Assistance Publique-Hôpitaux de Paris, Service d’Hématologie-Greffe, Hôpital Saint-Louis, Paris;3Université Paris-Diderot, Sorbonne Paris, Cité, Paris
Patricia Ribaud
1Assistance Publique-Hôpitaux de Paris, Service d’Hématologie-Greffe, Hôpital Saint-Louis, Paris;3Université Paris-Diderot, Sorbonne Paris, Cité, Paris
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.
