PREVENTION AND TREATMENT OF INVASIVE FUNGAL INFECTIONS IN PATIENTS WITH HEMATOLOGICAL MALIGNANCIES - RESULTS FROM A SINGLE HEMATOLOGICAL CENTRE
(Abstract release date: 05/19/16)
EHA Library. Serke G. 06/09/16; 134796; PB1896
Gabriella Serke
Contributions
Contributions
Abstract
Abstract: PB1896
Type: Publication Only
Background
Invasive fungal diseases could influence morbidity and early treatment-related mortality in patients of malignant hematological disorders treated with aggressive chemotherapy,especially in acute leukemias or after hematopoietic stem cell transplantation.
Aims
In an observational survey during 2010-2015 we investigated in our hematological department occurence of invasive systemic fungal infections(aspergillosis,systemic candidiasis,other species),methods of antifungal primary and secondary preventions and therapy of patients with acute myelogenous and lymphoblastic leukemias, lymphomas and transplant recipients according tot the criteria of EORTC/MSG,as well.
Methods
During suspect mycotic infection identification of pathogenic fungi specimens taken from blood and/or stool,bronchoalveolar lavage and histological analysis by autopsy,moreover chest/abdominal CT were performed (proven,probable and possible infections).Within period of survey 61 patients(pts)with acute myelogenous leukemia (AML),32 ones with acute lymphoblastic leukemia (ALL) treated with aggressive cytostatic regimens, in small number other patients of hematological malignancies with systemic fungal infections were also analysed. During prolonged neutropenia patiens were getting antimycotic prevention(in myelogenous leukemia rather posaconazol, in lymphoblastic leukemia mainly fluconazol,)in probable or proven mycotic infections such as in Candida infections first line liposomal AmphotercinB, echinocandins,or other second-line drugs (caspofungin), in suspect or manifest Aspergillus infection mostly voriconasol was given(empiric, pre-emptive or targeted treatment strategy).
Results
Systemic Candida infection proven by autopsy in four pts with AML (4/61),in three with ALL(3/32),Mucormyces in one with AML were diagnosed post mortem,probable candidiasis in five others (myeloma, lymphomas, chronic lymphocytic leukemia).Mold infection(Aspergillosis) proven by autopsy in 14/61 pts with AML, in 2 pts with ALL,and in two posttransplanted one, they survived after voriconazol therapy. In invasive Candida sepsis from 10 pts five expired,5 recovered,out of 25 pts with Aspergillosis 13 ones(chiefly pts with AML) died despite antimycotic treatment,mortality in both fungal infections was equal(50-50%).In remaining pts getting antimycotic prophylaxis during neutropenic episodes invasive fungal infections did not occured.
Conclusion
Incidence of Candida infections was higher in ALL, whilst of Aspergillosis in AML, however mortality rate was high and same in both groups.but recently due to the early introduction of pre-emptive antifungal therapy fatal outcome could be diminished. Antifungal prophylaxis in prolonged neutropenia reduced frequency and severity of systemic fungal manifestation resulted in better survival data in our leukemic patients.
Session topic: E-poster
Type: Publication Only
Background
Invasive fungal diseases could influence morbidity and early treatment-related mortality in patients of malignant hematological disorders treated with aggressive chemotherapy,especially in acute leukemias or after hematopoietic stem cell transplantation.
Aims
In an observational survey during 2010-2015 we investigated in our hematological department occurence of invasive systemic fungal infections(aspergillosis,systemic candidiasis,other species),methods of antifungal primary and secondary preventions and therapy of patients with acute myelogenous and lymphoblastic leukemias, lymphomas and transplant recipients according tot the criteria of EORTC/MSG,as well.
Methods
During suspect mycotic infection identification of pathogenic fungi specimens taken from blood and/or stool,bronchoalveolar lavage and histological analysis by autopsy,moreover chest/abdominal CT were performed (proven,probable and possible infections).Within period of survey 61 patients(pts)with acute myelogenous leukemia (AML),32 ones with acute lymphoblastic leukemia (ALL) treated with aggressive cytostatic regimens, in small number other patients of hematological malignancies with systemic fungal infections were also analysed. During prolonged neutropenia patiens were getting antimycotic prevention(in myelogenous leukemia rather posaconazol, in lymphoblastic leukemia mainly fluconazol,)in probable or proven mycotic infections such as in Candida infections first line liposomal AmphotercinB, echinocandins,or other second-line drugs (caspofungin), in suspect or manifest Aspergillus infection mostly voriconasol was given(empiric, pre-emptive or targeted treatment strategy).
Results
Systemic Candida infection proven by autopsy in four pts with AML (4/61),in three with ALL(3/32),Mucormyces in one with AML were diagnosed post mortem,probable candidiasis in five others (myeloma, lymphomas, chronic lymphocytic leukemia).Mold infection(Aspergillosis) proven by autopsy in 14/61 pts with AML, in 2 pts with ALL,and in two posttransplanted one, they survived after voriconazol therapy. In invasive Candida sepsis from 10 pts five expired,5 recovered,out of 25 pts with Aspergillosis 13 ones(chiefly pts with AML) died despite antimycotic treatment,mortality in both fungal infections was equal(50-50%).In remaining pts getting antimycotic prophylaxis during neutropenic episodes invasive fungal infections did not occured.
Conclusion
Incidence of Candida infections was higher in ALL, whilst of Aspergillosis in AML, however mortality rate was high and same in both groups.but recently due to the early introduction of pre-emptive antifungal therapy fatal outcome could be diminished. Antifungal prophylaxis in prolonged neutropenia reduced frequency and severity of systemic fungal manifestation resulted in better survival data in our leukemic patients.
Session topic: E-poster
Abstract: PB1896
Type: Publication Only
Background
Invasive fungal diseases could influence morbidity and early treatment-related mortality in patients of malignant hematological disorders treated with aggressive chemotherapy,especially in acute leukemias or after hematopoietic stem cell transplantation.
Aims
In an observational survey during 2010-2015 we investigated in our hematological department occurence of invasive systemic fungal infections(aspergillosis,systemic candidiasis,other species),methods of antifungal primary and secondary preventions and therapy of patients with acute myelogenous and lymphoblastic leukemias, lymphomas and transplant recipients according tot the criteria of EORTC/MSG,as well.
Methods
During suspect mycotic infection identification of pathogenic fungi specimens taken from blood and/or stool,bronchoalveolar lavage and histological analysis by autopsy,moreover chest/abdominal CT were performed (proven,probable and possible infections).Within period of survey 61 patients(pts)with acute myelogenous leukemia (AML),32 ones with acute lymphoblastic leukemia (ALL) treated with aggressive cytostatic regimens, in small number other patients of hematological malignancies with systemic fungal infections were also analysed. During prolonged neutropenia patiens were getting antimycotic prevention(in myelogenous leukemia rather posaconazol, in lymphoblastic leukemia mainly fluconazol,)in probable or proven mycotic infections such as in Candida infections first line liposomal AmphotercinB, echinocandins,or other second-line drugs (caspofungin), in suspect or manifest Aspergillus infection mostly voriconasol was given(empiric, pre-emptive or targeted treatment strategy).
Results
Systemic Candida infection proven by autopsy in four pts with AML (4/61),in three with ALL(3/32),Mucormyces in one with AML were diagnosed post mortem,probable candidiasis in five others (myeloma, lymphomas, chronic lymphocytic leukemia).Mold infection(Aspergillosis) proven by autopsy in 14/61 pts with AML, in 2 pts with ALL,and in two posttransplanted one, they survived after voriconazol therapy. In invasive Candida sepsis from 10 pts five expired,5 recovered,out of 25 pts with Aspergillosis 13 ones(chiefly pts with AML) died despite antimycotic treatment,mortality in both fungal infections was equal(50-50%).In remaining pts getting antimycotic prophylaxis during neutropenic episodes invasive fungal infections did not occured.
Conclusion
Incidence of Candida infections was higher in ALL, whilst of Aspergillosis in AML, however mortality rate was high and same in both groups.but recently due to the early introduction of pre-emptive antifungal therapy fatal outcome could be diminished. Antifungal prophylaxis in prolonged neutropenia reduced frequency and severity of systemic fungal manifestation resulted in better survival data in our leukemic patients.
Session topic: E-poster
Type: Publication Only
Background
Invasive fungal diseases could influence morbidity and early treatment-related mortality in patients of malignant hematological disorders treated with aggressive chemotherapy,especially in acute leukemias or after hematopoietic stem cell transplantation.
Aims
In an observational survey during 2010-2015 we investigated in our hematological department occurence of invasive systemic fungal infections(aspergillosis,systemic candidiasis,other species),methods of antifungal primary and secondary preventions and therapy of patients with acute myelogenous and lymphoblastic leukemias, lymphomas and transplant recipients according tot the criteria of EORTC/MSG,as well.
Methods
During suspect mycotic infection identification of pathogenic fungi specimens taken from blood and/or stool,bronchoalveolar lavage and histological analysis by autopsy,moreover chest/abdominal CT were performed (proven,probable and possible infections).Within period of survey 61 patients(pts)with acute myelogenous leukemia (AML),32 ones with acute lymphoblastic leukemia (ALL) treated with aggressive cytostatic regimens, in small number other patients of hematological malignancies with systemic fungal infections were also analysed. During prolonged neutropenia patiens were getting antimycotic prevention(in myelogenous leukemia rather posaconazol, in lymphoblastic leukemia mainly fluconazol,)in probable or proven mycotic infections such as in Candida infections first line liposomal AmphotercinB, echinocandins,or other second-line drugs (caspofungin), in suspect or manifest Aspergillus infection mostly voriconasol was given(empiric, pre-emptive or targeted treatment strategy).
Results
Systemic Candida infection proven by autopsy in four pts with AML (4/61),in three with ALL(3/32),Mucormyces in one with AML were diagnosed post mortem,probable candidiasis in five others (myeloma, lymphomas, chronic lymphocytic leukemia).Mold infection(Aspergillosis) proven by autopsy in 14/61 pts with AML, in 2 pts with ALL,and in two posttransplanted one, they survived after voriconazol therapy. In invasive Candida sepsis from 10 pts five expired,5 recovered,out of 25 pts with Aspergillosis 13 ones(chiefly pts with AML) died despite antimycotic treatment,mortality in both fungal infections was equal(50-50%).In remaining pts getting antimycotic prophylaxis during neutropenic episodes invasive fungal infections did not occured.
Conclusion
Incidence of Candida infections was higher in ALL, whilst of Aspergillosis in AML, however mortality rate was high and same in both groups.but recently due to the early introduction of pre-emptive antifungal therapy fatal outcome could be diminished. Antifungal prophylaxis in prolonged neutropenia reduced frequency and severity of systemic fungal manifestation resulted in better survival data in our leukemic patients.
Session topic: E-poster
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