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

Roni Bitterman; Setareh Davoudi; Laura N Walti; Meghan Aversa; Jonas Mattsson; Patrik Rogalla; Shahid Husain

doi:10.1016/j.ajt.2026.02.021

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

Am J Transplant. 2026 Feb 20:S1600-6135(26)00104-8. doi: 10.1016/j.ajt.2026.02.021. Online ahead of print.

Authors

Roni Bitterman¹, Setareh Davoudi², Laura N Walti², Meghan Aversa³, Jonas Mattsson⁴, Patrik Rogalla⁵, Shahid Husain²

Affiliations

¹ Transplant Infectious Diseases, Ajmera Transplant Centre, Division of Infectious Diseases, University Health Network, Toronto, Ontario, Canada. Electronic address: roni.bitterman@uhn.ca.
² Transplant Infectious Diseases, Ajmera Transplant Centre, Division of Infectious Diseases, University Health Network, Toronto, Ontario, Canada.
³ Toronto Lung Transplant Program, Ajmera Transplant Centre, Division of Respirology, University Health Network, Toronto, Ontario, Canada.
⁴ Allogeneic Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
⁵ Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada.

PMID: 41724437
DOI: 10.1016/j.ajt.2026.02.021

Abstract

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.

Keywords: allogeneic hematopoietic stem cell transplantation; computed tomography; invasive pulmonary aspergillosis; lung transplantation; survival.