Background: To evaluate the clinical characteristics and outcome of zygomycosis (ZG) in allogeneic hematopoietic stem cell transplant (HSCT) recipients. Methods: Retrospective cohort study involving HSCT patients with ZG diagnosed between 2003 and 2008, from 19 centres. During this period, 4138 allogeneic HSCT were performed in these centers. Results: ZG incidence was 0.56% (n=23). Twenty patients (87%) were male. Median age was 44 years (range: 3 to 63 years). Donors were non HLA-identical in 14 cases and conditioning regimens were reduced intensity in 8. ZG occurred a median of 217 days post transplant (range: 0 to 2693 days). Fifteen patients had active graft-versus-host disease (GVHD). Twenty patients were receiving steroids at a median dose of 1 mg/kg/day (range: 0.1 to 2 mg/kg/day) at ZG diagnosis. Ten patients (43%) had diabetes mellitus. Nine patients (39%) had experienced a previous proven or probable invasive filamentous fungal infection (Aspergillus: 8, Trichoderma:1) a median of 115 days (range: 8 to 392 days) before ZG diagnosis. ZG was a breakthrough infection in 20 cases. Before ZG diagnosis, 13 patients were on voriconazole therapy for a median duration of 61 days (range 3 to 394 days), 4 patients were on posaconazole (PCZ) for a median of 61 days (range 7 to 88 days). Other patients were receiving caspofungin, itraconazole or voriconazole. Lungs were the most common site of infection (65%); two patients had a disseminated infection. Histology was performed in 52% of the patients, and contributed to diagnosis for 83% of biopsies. Culture was positive in 83% of cases. The main causal species were Lichtheimia spp. and Rhizopus spp. Median time between the first clinical symptom and diagnosis was 8 days (range: 2 to 34 days). Twenty patients received an antifungal. All but 2 patients received a lipid formulation of amphotericin B as first-line treatment. Eleven patients received PCZ, two as first-line treatment. Surgery was performed in eight patients. Median treatment duration was 47 days (range: 2 to 730 days). Nine patients responded to treatment. Nineteen patients (83%) died a median of 46 days after ZG diagnosis (range: 0 to 1449 days). ZG attributable mortality was 79% (15/19 patients). Four patients are alive a median of 706 days after ZG diagnosis (range: 705 to 1955 days). Conclusion: ZG is a late event with a poor prognosis after allogeneic HSCT. Because ZG diagnosis is difficult, special attention must be paid to patients on long-term antifungal treatment for a previous mold infection, and with protracted GVHD.
Full conference title:
52nd American Society of Haematologists Annual Meeting
- ASH 52nd (2010)