EARLY AND AGGRESSIVE MANAGEMENT OF IFI IN ALLOTRANSPLANTED PATIENTS PRODUCES LOW MORBIDITY AND MORTALITY

V. Cancelli1,*, M. Malagola1, A. Turra1, C. Skert1, C. Filì1, C. Bergonzi1, R. Ribolla1, F. Cattina1, D. Russo1

Author address: 

1Chair of Hematology, Bone Marrow Transplant Unit, University of Brescia, AO Spedali Civili Brescia, Brescia, Italy

Abstract: 

Introduction: Invasive fungal infections (IFIs) are one of the most important  causes  of  morbidity  and  mortality  in  patients  submit-ted to allogeneic stem cells transplantation (SCT). Their incidence is  increasing  and  due  to  the  use  of  more  intensive  conditioning  regimens,  Graft  versus  Host  Disease  (GVHD)  prophylaxis,  higher  frequency of Matched Unrelated Donor (MUD), alternative hemo-poietic  stem  cells  sources  and  patients  >55  years  old.  We  here  report  on  morbidity  and  mortality  in  allotransplanted  patients  who  developed  an  IFI  and  who  have  been  early  and  aggressive  managed.

Materials  (or  patients)  and  Methods:  This  retrospective  single  center study includes 128 consecutive patients submitted to SCT from January 1, 2007 to December 31, 2012. 56/128 (44%) had an acute leukaemia, 25 (19%) had a lymphoma, 21 (16%) a multiple myeloma  and  the  remaining  had  other  onco-hematological  dis-orders.  The  disease  was  advanced  in  67/128  (52%)  and  patients  conditioned with reduced intensity regimen (RIC) were 84 (66%). Thirteen patients (10%) had previous fungal infection before SCT. Antifungal prophylaxis was fl uconazole in 41 patients (84%). Our approach  was  an  aggressive  monitoring  of  patients  with  febrile  neutropenia,  including  microbiological  (e.g.  Aspergillus  Antigen  and culture on Broncho-Alveolar Lavage) and radiological (e.g. HR CT) examination.

Results: Forty-nine (38%) patients developed an IFI. Four IFIs (8%) were  classifi  ed  as  proven,  3  (6%)  as  probable  and  42  (86%)  as  possible.  Proven  IFIs  were  due  to  Aspergillus  spp  in  3  cases  and  Mucor  in  one  patient.  No  Candida’s  IFI  were  documented.  Forty-one (84%) IFIs were diagnosed within 6 months from SCT, indicat-ing a clear relationship with conditioning regimens, neutropenia, immunosoppression and acute GVHD. First line therapy of IFIs was amphotericin b liposomal in 20 patients (41%), voriconazole in 15 (31%) and caspofungin in 14 (28%). Only 6 patients (12%) died for progression of fungal infection, the fungal free survival and over-all survival at 5 years was 88% and 55%, respectively.

Discussion: Between 2007 and 2012, the incidence of IFIs moved from 18% to 43% due to the increasing number of elderly patients, advanced status disease (44% in the 2007-2009 and 59% in 2011-2012) and the prevalence of unrelated donors’ choice. The absence of  Candida  IFIs  was  probably  due  to  fl uconazole-based  prophy-laxis,  that  is  used  routinely  in  this  setting.  Overall,  only  6  deaths  related  to  fungal  infection  progression  were  observed.  This  low  mortality  rate  could  be  achieved  thanks  to  an  aggressive  moni-toring of patients with febrile neutropenia, together with prompt initiation of antifungal therapy.Acknowledgments:  This  work  was  supported  in  part  by  Lions  Club Bassa Bresciana, Banca di Credito Cooperativo di Pompiano e Franciacorta

2014

abstract No: 

PH-P481

Full conference title: 

Annual Meeting of European Society for Blood and Marrow Transplantation
    • EBMT 40th (2014)