Epidemiology and treatment outcome of invasive fungal infections in patients with hematological malignancies.

Abstract

Invasive fungal infection (IFI) causes morbidity and mortality among patients with hematological malignancies who receive cytotoxic chemotherapy or hematopoietic stem cell transplantation (HSCT). We evaluated the incidence and treatment outcomes of proven and probable IFI in 22 institutions between 2006 and 2008 following the recent European Organization for Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG) consensus criteria. We analyzed 2,821 patients with hematological malignancies, including 597 who had undergone HSCT; these included patients with acute leukemia (n = 697), myelodysplastic syndrome (n = 284), lymphoma (n = 1465), or multiple myeloma (n = 375). IFIs were diagnosed in 38 (1.3%) patients (18 proven and 20 probable), including 20 patients who underwent HSCT and 18 who received chemotherapy alone; these included patients with aspergillosis (n = 23), candidiasis (n = 6), mucormycosis (n = 6), trichosporonosis (n = 2), and geotrichosis (n = 1). The incidence of IFI was 5.4 % in allogeneic HSCT patients, 0.4 % in autologous HSCT patients, and 0.8 % in patients receiving chemotherapy alone. Eighteen patients with aspergillosis were diagnosed with probable pulmonary IFI as determined by computed tomography scan and positive galactomannan assay. Overall, antifungal targeted therapies resulted in successful outcomes in 60.0 % of patients. IFI-attributable mortality rate was higher in HSCT patients than in those receiving chemotherapy alone, but the difference was not statistically significant.

• Authors: Mitsutoshi Kurosawa, Masakatsu Yonezumi, Satoshi Hashino, Junji Tanaka, Mitsufumi Nishio, Makoto Kaneda, Shuichi Ota, Kyuhei Koda, Nobuhiro Suzuki, Makoto Yoshida, Yasuo Hirayama, Rishu Takimoto, Yoshihiro Torimoto, Akio Mori, Tohru Takahashi, Susumu Iizuka, Tadao Ishida, Ryoji Kobayashi, Takanori Oda, Hajime Sakai, Satoshi Yamamoto, Fumihiko Takahashi, Takashi Fukuhara
• Journal: International journal of hematology (Int J Hematol) Vol. 96 Issue 6 Pg. 748-57 (Dec 2012) ISSN: 1865-3774 [Electronic] Japan
• PMID: 23111539 (Publication Type: Journal Article)

Chemical References

• Antifungal Agents

Topics

• Adolescent
• Adult
• Aged
• Antifungal Agents (therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
• Catheter-Related Infections (drug therapy, epidemiology)
• Child
• Child, Preschool
• Combined Modality Therapy
• Female
• Hematologic Neoplasms (complications, drug therapy, surgery)
• Humans
• Immunocompromised Host
• Infant
• Invasive Pulmonary Aspergillosis (drug therapy, epidemiology)
• Japan (epidemiology)
• Male
• Middle Aged
• Mycoses (drug therapy, epidemiology, etiology, microbiology)
• Neutropenia (chemically induced, complications)
• Opportunistic Infections (drug therapy, epidemiology, etiology)
• Postoperative Complications (drug therapy, epidemiology)
• Retrospective Studies
• Stem Cell Transplantation
• Treatment Outcome
• Young Adult