P-2293. Does Granulocyte-Macrophage Colony-Stimulating Factor as Adjunctive Therapy Affect Mortality in Patients with Hematologic Malignancies?
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background Invasive pulmonary aspergillosis (IPA) remains a major cause of illness and death in neutropenic patients (pts) with hematologic malignancies (HM). Because outcomes of IPA are mostly host-driven, adjunct host-targeted immunotherapies such as granulocyte-macrophage colony-stimulating factor (GM-CSF) have been used in cases of refractory or high-risk IPA, though the impact of GM-CSF on outcome remains unclear. Methods We reviewed records of all consecutive pts with HM and microbiologically documented IPA from sputum or bronchoalveolar lavage culture at MD Anderson Cancer Center (January 2016 - October 2021). Independent risk factors of 42-day (d) mortality and the impact of GM-CSF on outcomes were analyzed using multivariate Cox regression analysis. Results Of the 106 included IPA pts, 52 (49%) had leukemia/myelodysplastic syndrome and 54 (51%) had lymphoma/myeloma; 85 (80%) had active malignancy at IPA diagnosis (Figure 1). Thirty-two pts (30%) had a history of hematopoietic stem cell transplant and 37 (35%) had neutropenia < 100/µL at IPA diagnosis. Thirty-five pts (33%) received adjunct GM-CSF (Figure 1), started at a median of 3 d after initiating antifungal therapy (interquartile range [IQR] 1 – 18). The median duration of adjunct GM-CSF was 7 d (IQR 2 – 15). Forty-two-day all-cause mortality after IPA diagnosis was high (47%) and comparable in pts receiving GM-CSF and those who did not (51% vs. 45%, p = 0.54). Independent predictors of 42-d mortality were active HM (adjusted hazard ratio [aHR] 3.83, p = 0.026), neutropenia < 500/µL (aHR 1.83, p = 0.045), and albumin < 3 g/dL (aHR 2.45, p = 0.004) at IPA diagnosis (Table 1). Considering these co-variables and the timing of GM-CSF, the impact of adjunct GM-CSF on 42-d mortality remained insignificant (p = 0.19) in the multivariate Cox regression model (Table 1). Conclusion In a setting of significant IPA burden (i.e., culture-proven disease, neutropenic malnourished pts with active HM) and high overall mortality, adjunct GM-CSF therapy did not affect IPA outcomes. Early culture-independent biomarker-driven IPA diagnosis and immune markers for assessment of the host’s net state of immunosuppression will be pivotal to evaluate whether early preemptive deployment of host-targeted immunomodulators improves IPA outcomes in pts with HM. Disclosures Sebastian Wurster, MD, MSc, Astellas Pharma: Grant/Research Support|Gilead Sciences: Grant/Research Support Dimitrios P. Kontoyiannis, MD, AbbVie: Advisor/Consultant|Astellas Pharma: Advisor/Consultant|Astellas Pharma: Grant/Research Support|Astellas Pharma: Honoraria|Cidara Therapeutics: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|Gilead Sciences: Honoraria|Knight: Advisor/Consultant|Merck: Advisor/Consultant|Scynexis: Advisor/Consultant
Source: Open Forum Infectious Diseases
Institution: The University of Texas MD Anderson Cancer Center
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,053
OpenAlex ID: W4406954845