Association of follow-up chest computed tomography findings at 6 and 12 weeks with survival in people with invasive pulmonary aspergillosis following lung or allogeneic hematopoietic stem cell transplantation.

The prognostic value of radiologic response in invasive pulmonary aspergillosis remains poorly defined. We evaluated the association between radiologic responses at 6 and 12 weeks after diagnosis and survival in transplant recipients. We conducted a single-center retrospective cohort study of lung and allogeneic hematopoietic stem cell transplant recipients diagnosed with invasive pulmonary aspergillosis between 2010 and 2020. Patients were included if they had a follow-up chest computed tomography 4 to 15 weeks after diagnosis. Radiologic responses at 6 ± 2 and 12 ± 3 weeks were classified using European Organization for Research and Treatment of Cancer/Mycoses Study Group Education and Research Consortium criteria as complete, partial, stable, or progression. The primary outcome was all-cause mortality. We used a multivariable extended Cox proportional hazards model treating radiologic response as a time-dependent variable. Among 118 patients (79 lung and 39 allogeneic hematopoietic stem cell transplants), 56% (43 of 75) demonstrated a favorable radiologic response (complete or partial) at 6 weeks, increasing to 69% (59 of 86) at 12 weeks. In adjusted analyses, both complete (adjusted hazard ratio [aHR], 0.30; 95% confidence interval [CI], 0.17-0.52; P < .001) and partial (aHR, 0.32; 95% CI, 0.17-0.58; P < .001) responses were associated with improved survival. Stable response trended toward benefit (aHR, 0.45; 95% CI, 0.18-1.14; P = .093). Complete and partial radiologic responses to treatment were strongly associated with improved survival, underscoring the prognostic value of follow-up chest computed tomography at guideline-recommended intervals.