{"doi":"10.1016/j.jinf.2025.106535","title":"Blastemia portrays a poor prognosis in acute leukemia patients with invasive pulmonary aspergillosis","abstract":"OBJECTIVES: Severe and prolonged neutropenia is associated with poor outcomes of invasive pulmonary aspergillosis (IPA) in leukemia patients. Given the high frequency of IPA in patients with relapsed/refractory leukemia, we studied the association of peripheral blood blast burden (blastemia), IPA outcomes, and antifungal immune failure, even without neutropenia. METHODS: We retrospectively reviewed adult patients with acute leukemia (AL) or myelodysplastic syndrome and culture-positive proven/probable IPA (2011-2022). Blast and neutropenia indices were calculated and incorporated into multi-variable prognostic models. The impact of blasts on immune cell-mediated fungal clearance was studied in vitro. RESULTS: Among 74 patients, 69% had neutropenia and 57% had blastemia at IPA diagnosis. Blast index ≥90 at IPA diagnosis and ≥3 lines of prior chemotherapies were independent predictors of 42-day mortality and early antifungal treatment failure. Leukemic blasts had minimal immune activity against Aspergillus fumigatus and impaired fungal inhibition by peripheral blood mononuclear cells. CONCLUSION: Blastemia is common in contemporary leukemia patients with IPA and is a significant risk factor for poor IPA outcomes, possibly due to interference with fungal clearance by immune cells. Therefore, blastemia should be considered as a risk stratification parameter in future mycology trials and as an experimental variable in preclinical IPA models.","journal":"Journal of Infection","year":2025,"id":550728,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9405,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":301203,"name":"Sebastian Wurster","orcid":"0000-0002-7784-7256","position":1,"is_corresponding":false},{"id":1446268,"name":"Ying Jiang","orcid":"0000-0002-2530-6052","position":2,"is_corresponding":false},{"id":981375,"name":"Alexandre Bazinet","orcid":"0000-0001-5538-4943","position":3,"is_corresponding":false},{"id":728779,"name":"Hui Yang","orcid":"0000-0002-6125-5985","position":4,"is_corresponding":false},{"id":254610,"name":"Russell E. Lewis","orcid":"0000-0002-2002-4339","position":5,"is_corresponding":false},{"id":993214,"name":"Takahiro Matsuo","orcid":"0000-0001-9389-0628","position":6,"is_corresponding":false},{"id":425409,"name":"Nathaniel D. Albert","orcid":null,"position":7,"is_corresponding":false},{"id":112471,"name":"Guillermo Garcia-Manero","orcid":null,"position":8,"is_corresponding":false},{"id":95683,"name":"Dimitrios P. Kontoyiannis","orcid":"0000-0002-8051-2940","position":9,"is_corresponding":false},{"id":1446267,"name":"Sung‐Yeon Cho","orcid":"0000-0001-5392-3405","position":0,"is_corresponding":true}],"reference_count":31,"raw_metadata":null,"created_at":"2026-07-19T02:54:20.915388Z","pmid":"40532856","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}