Clinical Characteristics of Patients with Hematologic Malignancies and Invasive Aspergillosis: A Cross-Sectional Clinical Report from Iran

The incidence of invasive aspergillosis (IA) has significantly increased in recent decades. In patients with hematologic malignancies (HM), IA is associated with higher mortality rates.

This study aimed to assess the clinical features of IA in patients with HM.

In this retrospective study, we utilized the hospital information system (HIS) database to extract clinical and paraclinical characteristics of patients with variousHMswhoreceived a diagnosis of probable or proven IA during their hospitalization atImam Khomeini Hospital Complex in Tehran, Iran, between March 2018 and March 2022

Among350 patients withHMevaluated, 51 patients (14.6%) were identified as having IA, including 40 cases (78.4%) classified as probable and 11 (21.6%) as proven. Among these, 34 individuals (66.7%) were male. The most common symptoms included fever (n = 23, 62.7%), cough (n = 20, 39.2%), and fever that did not respond to antibiotic therapy (n = 16, 31.4%). The most prevalent malignancies wereAML(n = 28, 54.9%), ALL (n = 16, 31.4%), andlymphoma(n = 7, 13.7%). Out of the 51 patients withHMand IA, 48 (94.1%) had abnormal findings on chest CT scans, with the majority (n = 31, 72.1%) showing a nodule with a halo sign. Aspergillus flavus (n = 19/24, 79.2%) was the most commonly isolated species. Initially, patients received liposomal amphotericin B or caspofungin as empiric antifungal therapy, which was then switched to voriconazole once the diagnosis of IA was probable or proven. Eight patients (15.6%) did not survive.

Patients with HM presenting with fever and cough should undergo close monitoring for IA. A higher incidence of IA is observed in AML patients, and voriconazole could be considered as antifungal prophylaxis in HM patients. A. flavus is likely the most frequent cause of IA in Iranian patients with HM.