TREATMENT OUTCOMES OF INVASIVE MOLD INFECTIONS (IMI) AMONG HEMATOPOIETIC CELL TRANSPLANT (HCT) PATIENTS

J. Ito1*, J. Kriengkauykiat1, M. Kim1, K. Ogawa1, B. Tegtmeier1, S. Dadwal1, S. Forman1

Author address: 

1City of Hope National Medical Center

Abstract: 

Purpose: Recipients of HCT are at increased risk for IMI. We sought to determine incidence and effects of antifungal treatment on outcomes including response and mortality. Methods: Patients were identified by pathology and microbiology databases between 2000 and 2007. Proven and probable IMI cases were included. Data was collected retrospectively and included demographics, underlying disease, date of infection onset, antifungal prophylaxis and treatment (up to 90 days after onset of infection), outcomes (response, 90 day mortality). Results: Overall IMI incidence was 4.5% (159 per 3495 HCT), 3.4% (n=119) for invasive aspergillosis (IA), and 0.46% (n=16) for zygomycosis (ZY). There is a decreasing trend over time for incidence of IMI (average 0.25%/year) and IA (0.13%/year), but a small increase for ZY (0.013%/year). ZY accounted for only 10% (16/159) of IMI in recent years. Of 153 evaluable cases, 90% (n=137) were allogeneic HCT, 60% (n=92) had leukemia, and 66% (n=102) had graft versus host disease (GVHD) recently resolved GVHD at time of diagnosis. A majority (60%, 92/153) developed IMI beyond the acute phase (>100 days), and 37%(56/153) developed IMI beyond 1-year post-HCT. Almost all patients (93%, 142/153) were on either steroids or immunosuppressants. Most (71%, 109/153) broke through on prophylaxis. Patients who initially had partial response (PR) to treatment (n=44), 59% (n=26) had complete or PR, while those who had stable disease, 57% (n=16) died at 90 days. Acute GVHD was associated with a low response rate (11%, 2/19) compared to recently resolved or no GVHD (31%, 19/62). Response was highest with voriconazole as primary therapy, 88% (15/17) compared to overall, 29% (44/153). 90-day survival rate was 37% (57/153) with 67% (38/57) fungal free survival. A 90-day survival advantage was found with the advent of voriconazole when compared to pre-voriconazole era (p 0.004). No survival advantage was found when comparing earlier to later time periods either prior to or after arrival of voriconazole. Conclusions: Trends of declining rates of IMI and IA have been observed. There have been no significant increases of ZY recently and remains
2010

abstract No: 

154

Full conference title: 

4th Advances Against Aspergillosis
    • AAA 4th (2010)