EIJI KUSUMI, MD, Toranomon Hosp., Tokyo, Japan; MIWA SAKAI, MD, Tokyo Metropolitan Komagome Hosp., Tokyo, Japan; YUJI TANAKA, MD, National Cancer Ctr. Hosp., Tokyo, Japan; YOSHINOBU KANDA, MD, Univ. of Tokyo, Tokyo, Japan; SHIGESABURO MIYAKOSHI, MD, Toranomon Hosp., Tokyo, Japan; HISAMARU HIRAI, MD, Univ. of Tokyo, Tokyo, Japan; HISASHI SAKAMAKI, MD, Tokyo Metropolitan Komagome Hosp., Tokyo, Japan; YOSHITOMO MUTOU, MD, Toranomon Hosp., Tokyo, Japan and YOICHI TAKAUE, MD, National Cancer Ctr. Hosp., Tokyo, Japan Object: To evaluate the incidence and characteristics of IA following RIST in comparison with those after CST. Methods: We examined the medical records of 685 patients (median age, 40 y) who received allogeneic transplantation from 1999 through 2002; 498 patients received CST, while 185 received RIST. The primary diseases were hematological diseases (151 in RIST and 498 in CST) and solid tumors (n34, all in RIST). In CST, the preparative regimen included a TBI-based (n299), and a BU/CY-based (n199). In RIST, the preparative regimen was fludarabine- (n159) or cladribine-based (n26), with or without rabbit ATG. In CST, GVHD prophylaxis consisted of cyclosporin (CSP) alone (n14), CSP plus short-term methotrexate (s-MTX, n428), FK506 (n3), FK506 plus s-MTX (n44), and others (n2), while in RIST it consisted of CSP (n125), CSP plus s-MTX (n57), and others (n3). A diagnosis of IA was made based on EORTC criteria. Results: Twenty-two of the 498 CST patients (4.4%) and 14 of the 185 RIST patients (7.6%) developed IA, with the estimated one-year incidence of IA, calculatedspecies. However studies evaluating risk factors, clinical manifestations and outcome of MSC have not been reported. Methods: We searched the microbiological laboratory reports from 1993 to 2000 and identified 33 patients with 2 species of Candida in one or more blood cultures within 72 h. Sixty-six cases of C. albicans fungemia that occurred most closely in time (before or after each case of MSC) were chosen as the control group (2:1 ratio). Information regarding patients’ demographics, risk factors, treatment and outcome were retrospectively collected. Results: MSC patients were more likely to have had prolonged neutropenia prior to onset of infection (10 17 days vs. 3 6 days, p 0.02), and received chemotherapy within thirty days prior to infection (70% vs. 42%, p 0.01). Patients with MSC more often had an APACHE II score 16 (46% vs. 26%, p 0.05), and developed breakthrough fungemia during antifungal prophylaxis (33% vs. 11%, p 0.006). The response of C. albicans fungemia to single agent antifungal treatment was significantly better than that of MSC (69% vs.35%, p 0.01). However, the response of MSC to antifungal combination was comparable to the response of C. albicans fungemia to single agent treatment (75% vs. 69%, p NS). Conclusions: MSC is more likely to occur as a breakthrough fungemia and occurs predominantly in patients with prolonged neutropenia. Response to single agent antifungal treatment was poor. Further studies are needed to determine whether combination therapy can improve outcome.
Full conference title:
41st Annual Meeting Infectious Diseases Society of America
- Infectious Diseases Society of America 41st