# Clinical Characteristics and Outcomes of Invasive Aspergillosis in Patients with Hematological Malignancies and Transplantation and Cellular Therapies in the Contemporary Era

## TL;DR

This study examines the clinical features and outcomes of invasive aspergillosis in patients with blood cancers and transplants, finding high mortality rates despite modern treatments.

## Contribution

The study provides contemporary data on invasive aspergillosis outcomes in hematological patients, highlighting the need for improved antifungal strategies.

## Key findings

- 44% of cases were breakthrough invasive aspergillosis despite treatment.
- All-cause mortality was 22% at 30 days and 46% at 90 days.
- Therapeutic antifungal levels were linked to reduced mortality.

## Abstract

Despite important advancements in diagnostic modalities, routine use of therapeutic drug monitoring (TDM) and newer antifungal therapies, there is a paucity of contemporary data regarding clinical characteristics and outcomes of invasive aspergillosis (IA) in the United States.

Single-center, retrospective cohort study of hospitalized patients between 2015 and 2020, who had active hematological malignancy (HM) or had undergone transplantation and cellular therapy (TCT) and had probable or proven IA.

Sixty-two patients with probable or proven IA, including 21 HM and 41 TCT, were identified. Forty-four percent of the cases corresponded to breakthrough IA. Bronchoalveolar lavage galactomannan was ≥ 1 in 71% and ≥ 0.5 in 88%, while serum galactomannan was ≥ 0.5 in only 34%. Among assessable patients (n = 59), 90-day partial or complete response to antifungal therapy occurred in 39%. All-cause mortality for the entire cohort was 22% at 30 days and 46% at 90 days. IA attributable mortality was 18% at 30 days and 38% at 90 days. Achieving therapeutic antifungal serum levels was associated with a reduction in all-cause mortality, while prior clinically significant CMV infection (aOR 9.65, 95% CI 1.34–69.6; P = 0.025) and relapsed/refractory hematological disease (aOR 8.5, 95% CI 2.23, 32.4; P = 0.002) were associated with higher IA attributable mortality.

Despite advancements in diagnosis and treatment, IA remains associated with poor outcomes in hematological patients in the contemporary era. Newer antifungals and improved strategies for monitoring and prevention of IA in these vulnerable patient populations are urgently needed.

The online version contains supplementary material available at 10.1007/s11046-025-01046-1.