Older patients with high-risk fungal infections can be successfully allografted using non-myeloablative conditioning in combination with intensified supportive care regimens.

Abstract

Leukaemic patients with advanced disease and severe fungal infections as well as older patients with substantial co-morbidity are usually excluded from conventional allotransplantation because of increased morbidity and mortality. We approached allogeneic transplantation in four patients with a median age of 62 years (one chronic myeloid leukaemia in blast crisis, one high-risk acute myeloid leukaemia (AML) in first complete remission (CR1), one AML in 2nd relapse, one AML in CR2 with pre-existing fungal lung infections (two aspergillus, two mucor) and additional co-morbidity (diabetes n = 2, aortic aneurysm n = 1, arterial sclerosis n = 2) by combining non-myeloablative conditioning with an intensified supportive care regimen, including amphotericin B and 4-12 (median 9) prophylactic granulocyte transfusions from granulocyte colony-stimulating factor (G-CSF)-stimulated volunteer donors. G-CSF was also given to patients until neutrophil recovery. All four patients recovered to a neutrophil count of 0.5 x 109/l after a median of 11.5 d (range 11-13 d). Prophylactic granulocyte transfusions also reduced the need for platelet transfusions and minimized mucositis. All patients were discharged at a median of 25 d (range 18-59 d) and are alive and well after a median follow-up of > 390 d (range 336-417 d) without evidence of leukaemia. Regression of the fungal lesions was documented in three patients, with a slight progression detected by computerized tomography scan of the chest in one patient. We conclude that pulmonary fungal infections are not a contraindication for allogeneic stem cell transplantation, if non-myeloablative conditioning regimens are used in combination with granulocyte transfusions, intravenous amphotericin B and G-CSF.

• Authors: S Hermann, S A Klein, V Jacobi, A Thalhammer, H Bialleck, M Duchscherer, B Wassmann, D Hoelzer, H Martin
• Journal: British journal of haematology (Br J Haematol) Vol. 113 Issue 2 Pg. 446-54 (May 2001) ISSN: 0007-1048 [Print] England
• PMID: 11380415 (Publication Type: Journal Article)

Chemical References

• Antifungal Agents
• Granulocyte Colony-Stimulating Factor
• Amphotericin B

Topics

• Acute Disease
• Amphotericin B (therapeutic use)
• Antifungal Agents (therapeutic use)
• Aortic Aneurysm (complications, surgery)
• Arteriosclerosis (complications, surgery)
• Aspergillosis, Allergic Bronchopulmonary (complications, drug therapy, surgery)
• Bone Marrow Transplantation
• Cell Count
• Diabetes Complications
• Diabetes Mellitus (surgery)
• Granulocyte Colony-Stimulating Factor (therapeutic use)
• Humans
• Leukemia (drug therapy, microbiology, surgery)
• Leukemia, Myeloid (drug therapy, microbiology, surgery)
• Leukemia, Myeloid, Chronic-Phase (drug therapy, microbiology, surgery)
• Lung Diseases, Fungal (complications, drug therapy, surgery)
• Male
• Middle Aged
• Neutrophils (pathology)
• Platelet Count
• Recurrence
• Remission Induction
• Tomography, X-Ray Computed
• Transplantation, Homologous
• Treatment Outcome