The prognostic value of radiologic response in invasive pulmonary aspergillosis (IPA) 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 IPA between 2010-2020. Patients were included if they had follow-up chest CT 4-15 weeks after diagnosis. Radiologic responses at 6±2 and 12±3 weeks were classified using EORTC/MSGERC 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, 39 allogeneic hematopoietic stem-cell transplants), 56% (43/75) demonstrated a favorable radiologic response (complete or partial) at 6 weeks, increasing to 69% (59/86) at 12 weeks. In adjusted analyses, both complete (aHR 0.30, 95% 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 CT at guideline-recommended intervals.
Stern et al. (Sun,) studied this question.