A total of 51 males and 35 females (9m - 81 y.o.) with definite or probable CNSA were given VRC Rx, including 46 with biopsy +ve brain or CSF. Brain/other biopsies yielded A. fumigatus 34 pts, A. nidulans 5, aspergillus spp 24. Underlying conditions were BMT (33 pts), hematologic malignancy (14) solid organ transplant (12), acquired/congenital immunosuppression (15), other (12). Only 13/86 pts received primary VRC Rx (2600d]. Investigators assessed a complete/partial response in 34% (VRC Rx; median 222d, range 8 - 1128) and stable/failed response in 66% (VRC Rx: median 18d, range 1 - 514). Underlying condition impacted response and survival (15% response in BMT but 42 - 50% all others; known survival - 21% BMT, 14% hematologic malignancy, 33% - 67% all others). Death day from starting VRC was known for 59 pts (median 33d, range 3 - 418) and death was ascribed to fungal infection in 39 (66%). Known survival duration for the remaining 27 pts was median 222d (range 10 - 1128). There were 518 all causality adverse events (AEs) in 78/86 pts (91%). The investigators ascribed most to underlying condition or CNSA, but 67 (13%) AEs in 34pts were considered possibly VRC-related. Most common VRC-related AEs were raised LFTs (13pts), visual events (8) and rash (7). In 21 pts where Rx was discontinued due to AEs, they were VRC-related in 7 (elevated LFTs 3pts, cutaneous eruption 1, acute pancreatitis 1, bone marrow aplasia 1, tachyarrythmia 1). VRC is a promising Rx for CNS aspergillosis.
Full conference title:
43rd Interscience Conference on Antimicrobial Agents
- ICAAC 43rd