PB2031 INVASIVE ASPERGILLOSIS IN ELDERLY ONCOHEMATOLOGICAL PATIENTS

Abstract

Background:Invasive aspergillosis (IA) in elderly patients is not well understood.Aims:Analysis of underlying diseases, risk factors, etiology, clinical features, treatment and survival rates in elderly patients with IA.Methods:Retrospective analysis of the register data in 1998‐2018 yy. We included 646 adultpatients with proven and probable IA. For diagnosis of IA we used criteria EORTS/MSG, 2008.Results:In group I we included 137 patients with IA ≥ 60 years old, males – 60%. The control group consisted of 509 patients aged from 18 to 59 years, males – 53%. Oncohematological diseases were less frequent in elderly patients – 77% vs 87%, p = 0,002. In this patients non‐Hodgkin's lymphoma prevailed (35% vs 13%, p <0.05) among underlying diseases, whereas other hematologic diseases were less common: acute lymphoblastic leukemia (6% vs 13%, p < 0.05), Hodgkin's lymphoma (6% vs 13%, p < 0.05). Non‐hematological diseases were more frequent in elderly patients (23% vs 13%, p = 0.002). We identified differences in risk factors between the two groups: prolonged agranulocytosis was detected in 59% vs 75%, (p = 0.0003), lymphocytopenia ‐ 45% vs 60%, (p = 0.002).Significantly smaller numbers of elderly patientswere recipients of allogeneic stem cell transplants (3% vs 26%, p = 0.00001) and received immunosuppressive therapy (17% vs 31%, p = 0.0002). No significant differences were obtained in the localization of the fungal infection, as well as in clinical symptoms and results of galactomannan test. Aspergillusspp. were isolated more often in elderly patients (52% vs 40%, p = 0,01). The main etiological agents wereA. fumigatus (59% vs 45%) and A. niger (25% vs 34%). Mixed fungal infection was found in 9% vs 11% patients. Antifungal therapy was used in most of patients, the main drug used was voriconazole (73% vs 72%). Twelve weeks overall survival rate was 82% vs 79%.Summary/Conclusion:Oncohematological diseases were less frequent in elderly patients – 77%.The features of risk factors in elderly patients was less severe immunosuppression: prolonged agranulocytosis – 59%, lymphocytopenia – 45%, immunosuppressive therapy ‐ 17%, allogeneic stem cell transplants – 3%. The overall 12‐week survival in elderly patients with IA was not significantly different (82% vs 79%).