355. Invasive Pulmonary Aspergillosis (IPA) Complicating Respiratory Viral Infections in Patients With Hematological Malignancies

Abstract

BackgroundData regarding respiratory viral infections (RVIs) in patients with leukemia and/or stem cell transplantation (LSCT) and their predisposition to invasive pulmonary aspergillosis (IPA) are limited. To that end, we conducted a case–control study of post-RVI-IPA in LSCT patients.MethodsWe analyzed all consecutive adult patients (2006–2016) with culture-documented IPA (EORTC/MSG criteria). Cases were patients with confirmed (either by nasal wash and/or BAL PCR and/or respiratory viral culture) RVIs [respiratory syncytial virus (RSV), Influenza A/B (INFA/B), or parainfluenza virus (PIV)] followed by IPA up to 5 weeks after. Controls were patients with IPA without evidence of RVIs.ResultsWe identified 54 cases (proven 1, probable 53), and 142 patients with IPA (proven 12, probable 130) as controls. The distribution of viruses were 34 PIV (52%), 18 INFA/B (27%), and 14 RSV (21%). The median days of post-RVIs-IPA infection was 8(−6–57) days. Among cases, the most common hematological malignancies were AML (34%) and CLL (26%). Most cases had prior allogeneic SCT (57%). Non-fumigatus Aspergillus species were the cause of IPA in 58% of cases. In univariate analysis, patients with post-RVs-IPA infection were more likely to be in complete or partial remission (43.9% vs. 22.3% P = 0.007), to have prior allogeneic SCT (57% vs. 31%, P = 0.0009) and an absolute lymphocyte count between 500 and 1,000/mm3 at RVI diagnosis (41% vs. 27%, P = 0.04). In addition, coinfections within 2 weeks after viral infection (58% vs. 18%, P = 0.0001), especially of the lower respiratory tract (37% vs. 18%, P = 0.004) were more common in patients with post-RVIs-IPA. RVIs-IPA patients were less likely to have an absolute neutrophil count <100 mm3 at IPA diagnosis (17% vs. 37%, P = 0.005). Need for ICU post-RVIs-IPA disease (31% vs. 26% P = 0.5) and 42 days crude mortality (22% vs. 27%, P = 0.45) were no different between cases and controls.ConclusionPost-RVIs-IPA occurs more frequently in patients with prior transplantation and is less associated with leukemia relapse and neutropenia. Although co-infections are common, this entity does not appear to be associated with worse outcome compared with IPA without preceding RVI.Disclosures D. P. Kontoyiannis, Merck: Consultant, Research support and Speaker honorarium. Pfizer: Consultant, Research support. Astellas: Consultant, Research support and Speaker honorarium. Gilead: Speaker’s Bureau, Speaker honorarium. F2G Inc.: Speaker’s Bureau, Speaker honorarium. Cidara Inc.: Speaker’s Bureau, Speaker honorarium. Jazz Pharmaceuticals: Speaker’s Bureau, Speaker honorarium.