Sinus Surgery (SS) Improves the Outcome of Invasive Aspergillus Sinusitis in Neutropenic Patients with Hematologic Malignancy (HM)

RAY HACHEM, MD, MAHA BOKTOUR, MD, HEND HANNA, MD, MPH, DIMITRIOS KONTOYIANNIS, MD, XAVIER KEUTGEN, MD, BASSAM SHUKRALLAH, MD, EHAB HANNA, MD, ISSAM I. RAAD, MD;

Author address: 

University of Texas, M.D. Anderson Cancer Center, Houston, TX.

Abstract: 

Background: Invasive Aspergillus sinusitis (IAS) is associated with high mortality and poor response to antifungal therapy in HM patients. We therefore conducted this study to determine whether sinus surgery (SS) could improve the outcome of IAS. Methods: Medical records of patients treated at our tertiary cancer center from 1993 to 2005 were reviewed retrospectively. We identified 353 HM patients with invasive aspergillosis of whom 39 patients had IAS. Of the 39 cases, 11 patients underwent SS in addition to the antifungal therapy, and the remaining 28 control patients received antifungal therapy alone. The diagnosis was made according to the Mycosis Study Group (definite and probable). SS included debridement of grossly necrotic/infected tissue, and whenever possible radical excision with histopathologic negative margins. Response to antifungal therapy as well as the impact of surgery on the ultimate outcome was determined. Results: Most patients with IAS had underlying leukemia 33/38 (84%). Aspergillus flavus was identified in 20/39 (51%), the most common species causing this infection. Both groups had comparable clinical characteristics such as, gender, age, underlying disease, neutropenia at the onset, persistent neutropenia, graft-versus-host-disease, and comparable antifungal therapy. Overall response was 45.5% in the SS group vs 21.4% in the control group ( p = 0.23). Among the subgroup of patients with neutropenia at the onset of infection, the response rate in the SS group was significantly better than in the non-SS group 4/7 (57%) vs 2/11 (11%) respectively ( p = 0.032). Conclusion: In neutropenic patients with IAS and underlying HM, SS significantly improved the outcome. Hence, in this neutropenic patients population where antifungal therapy has a limited activity SS should be considered.
2006

abstract No: 

556

Full conference title: 

Infectious Diseases Society of America, 44th Annual Meeting
    • IDSA 44th