Increase in Non-Aspergillus mold infections in recipients of allogeneic bone marrow transplantation (BMT) at Memorial Sloan-Kettering Cancer Center (MSKCC)

Hoyos C.M.J., Chung D., Amigues I., Pamer E., Jakubowski A.m Papanicolaou G.

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Invasive Aspergillosis (IA) is the most common Invasive Mold Infection (IMI) in BMT. An increase in Non-Aspergillus Mold (NAM) infections has been reported in cancer patients. NAM infections had been extremely rare in BMT at MSKCC. We describe the epidemiology ofNAM infections at MSKCC during 2006-2008. METHODS: All patients had BMT for hematologic malignancies at MSKCC. The incidence of IMI was determined by prospective surveillance for two 3 year study periods: January 2000- December 2002 (Cohort A) and January 2006- December 2008 (Cohort B). EORTC/MSG criteria were used for diagnosis. Serum Galactomannan for diagnosis and voriconazole prophylaxis were available for Cohort B only. RESULTS: Cohorts A and B were comprised of 240 and 397 patients respectively. The incidence ofIMI was 7.S% and S.S% respectively. NAM accounted for 6% of alllMls in Cohort A and 28% in Cohort B. In cohort A 1 patient (0.4%) had mucormycosis. In cohort B 6 patients (.5%) had NAM: Rhizopus 4, Absidia I, Scedosporium L Median time to diagnosis was 218.S days (range 21-443). 3 of 6 patients (50%) with NAM infections also had Invasive Aspergillosis. All patients had prolonged courses of voriconazole prior to diagnosis of IMI. Diagnosis was antemortem in 4 of the 6 patients (66.6%). Mortality was 83%. CONCLUSIONS: I) During the time interval between January 2006 and December 2008 there was an overall decrease of 26% in IMI but a relative increase in Non Aspergillus Mold infections of 78%. 2) SO% of NAM cases also had IA. 3) Voriconazole and intense immunosuppression may partially account for the rise in NAM infections in BMT. 4) Local surveillance and clinical suspicion are important for timely diagnosis and treatment

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17th International Society for Human and Animal Mycology
    • ISHAM 17th (2009)