Twenty-six cases of Blastoschizomyces capitatus infection were diagnosed in 25 patients at 7 tertiary care hematology units in Spain over a 10-year period. Most patients (92%) had acute leukemia and developed infection during a period of severe and prolonged neutropenia. Two patients had esophagitis, and the rest had invasive infection. Fungemia (20 cases) was a common finding, with frequent visceral dissemination. The 30-day mortality associated with this infection was 52%, compared with 57% among patients with systemic infection. In a univariate analysis, the following 3 variables had a positive impact on 30-day survival: removal of the central venous catheter within 5 days after the onset of infection (P=.02), a good performance status (P=.003), and receipt of systemic prophylactic or empirical antifungal therapy before infection onset (P=.006). Outcome for neutropenic patients with B. capitatus infection is still poor. Rapid removal of the central venous catheter and novel antifungal therapies are recommended for treatment of this rare infection.

Patients from groups BA and BB presented with a significantly higher number of adverse prognostic factors, reflecting that we were dealing with high tumor MM cases, as compared with patients from group AA. The number of mononuclear cells, CD34+ cells and CFU-GM cells collected in patients with non-reversible renal insufficiency was similar to those harvested in MM patients with normal renal function. Moreover, neutrophil and platelet engraftments were identical in patients with and without renal failure (days +11 and +12, respectively). By contrast, transplant-related mortality (TRM) was significantly higher in group BB patients (29%) than in groups BA (4.1%) and AA (3.3%). In multivariate analysis only three variables showed independent influence on TRM: poor performance status (ECOG 3), hemoglobin <9.5 g/dl and serum creatinine > or =5 mg/dl. The response to high dose therapy was independent of renal function. Interestingly, 43% of patients from group BB showed an improvement in renal function (creatinine < 2 mg/dl) after transplant. The three-year overall survival from transplantation was 56, 49 and 61% for the BB, BA and AA groups, respectively, with a statistically significant difference favoring group AA (P<0.01). PFS did not differ significantly between the three groups of patients. In multivariate analysis the only unfavorable independent prognostic factors for overall survival were poor performance status either at diagnosis or at transplant, high beta(2)-microglobulin levels, and no response to transplant. According to these results, ASCT is an attractive alternative for MM patients with renal insufficiency, and it should not constitute a criterion for exclusion from transplant unless patients display poor performance status and very high creatinine levels (>5 mg/dl).

There is limited information on the characteristics, prognostic factors, and outcomes of patients with multiple myeloma (MM) hospitalized with COVID-19. This retrospective case series investigated 167 patients reported from 73 hospitals within the Spanish Myeloma Collaborative Group network in March and April, 2020. Outcomes were compared with 167 randomly selected, contemporary, age-/sex-matched noncancer patients with COVID-19 admitted at six participating hospitals. Among MM and noncancer patients, median age was 71 years, and 57% of patients were male; 75 and 77% of patients, respectively, had at least one comorbidity. COVID-19 clinical severity was moderate–severe in 77 and 89% of patients and critical in 8 and 4%, respectively. Supplemental oxygen was required by 47 and 55% of MM and noncancer patients, respectively, and 21%/9% vs 8%/6% required noninvasive/invasive ventilation. Inpatient mortality was 34 and 23% in MM and noncancer patients, respectively. Among MM patients, inpatient mortality was 41% in males, 42% in patients aged >65 years, 49% in patients with active/progressive MM at hospitalization, and 59% in patients with comorbid renal disease at hospitalization, which were independent prognostic factors on adjusted multivariate analysis. This case series demonstrates the increased risk and identifies predictors of inpatient mortality among MM patients hospitalized with COVID-19.

Seven cases of disseminated infection due toCase 2. The patient in case 2 was a 76-year-old male with a relapse of an acute myeloblastic leukemia. Severe neutropenia developed, the patient became febrile, and blood cultures were obtained. Fever persisted in spite of empirical antibiotic treatment with ceftazidime, amikacin, and vancomycin. Three days after antibacterial treatment, skin nodules appeared and a chest radiograph revealed new bilateral lung infiltrates. Conventional AMB, 1 mg/kg of body weight/day, was added to his treatment regimen. The patient remained febrile and died 5 days later. D. capitatus grew on all blood cultures.Case 3. The patient in case 3 was a 42-year-old male with a relapse of an acute myeloblastic leukemia, type M2, who had been diagnosed 5 years before. Eight days after the chemotherapy was finished, he became febrile and neutropenic. Blood cultures were taken and yielded Escherichia coli and viridans group Streptococcus that responded to treatment with meropenem plus vancomycin. Three days later his fever reappeared, and it was accompanied by tachypnea, diarrhea, and stupor. Blood cultures were drawn, chest radiography revealed new bilateral infiltrates, and conventional AMB was added to his treatment regimen. The patient died of septic shock. Blood cultures yielded D. capitatus.Case 4. The patient in case 4 was a 44-year-old female with a B prolymphocytic leukemia with disease progression in spite of fludarabine and CHOP (cyclophosphamide, hydroxydaunomycin, vincristine [oncovin], and prednisone) treatment. Pentostatin-prednisone was administered but caused severe hematological toxicity. The patient developed pancytopenia, fever, and lung consolidation, and empirical antibacterial treatment and conventional AMB, 1 mg/kg/day, were administered in combination with granulocyte-macrophage colony-stimulating factor. The patient died of septic shock. D. capitatus grew from respiratory samples and blood cultures.Case 5. The patient in case 5 was a 76-year-old female who was diagnosed with acute myeloblastic leukemia. During the administration of chemotherapy, the patient became febrile and responded to treatment with piperacillin-tazobactam plus amikacin. Leptotrichia buccalis was isolated from blood cultures. While she was receiving the antibacterial agents, she became febrile again and a lung consolidation was seen upon chest radiography. Other blood cultures were performed, vancomycin was added to her treatment regimen with no response, and the patient was asked to join a double-blind clinical trial for febrile neutropenia of suspected fungal etiology. The clinical trial compared treatments with caspofungin and liposomal AMB. The patient accepted and was included in the clinical trial. The patient seemed to improve the first 2 days but suddenly worsened, showing jaundice, tachypnea, and pleural ef-* Corresponding author. Mailing address: Unidad de Micología,

There is limited information on the characteristics, pre-admission prognostic factors, and outcomes of patients with multiple myeloma (MM) hospitalized with coronavirus disease 2019 (COVID-19). This retrospective case series investigated characteristics and outcomes of 167 MM patients hospitalized with COVID-19 reported from 73 hospitals within the Spanish Myeloma Collaborative Group network in Spain between March 1 and April 30, 2020. Outcomes were compared with a randomly selected contemporary cohort of 167 age-/sex-matched non-cancer patients with COVID-19 admitted at 6 participating hospitals. Common demographic, clinical, laboratory, treatment, and outcome variables were collected; specific disease status and treatment data were collected for MM patients. Among the MM and non-cancer patients, median age was 71 years and 57% of patients were male in each series, and 75% and 77% of patients, respectively, had at least one comorbidity. COVID-19 clinical severity was moderate-severe in 77% and 89% of patients and critical in 8% and 4%, respectively. Supplemental oxygen was required by 47% and 55% of MM and non-cancer patients, respectively, and 21%/9% vs 8%/6% required non-invasive/invasive ventilation. Inpatient mortality was 34% and 23% in MM and non-cancer patients, respectively. Among MM patients, inpatient mortality was 41% in males, 42% in patients aged >65 years, 49% in patients with active/progressive MM at hospitalization, and 59% in patients with comorbid renal disease at hospitalization, which were independent prognostic factors of inpatient mortality on adjusted multivariate analysis. This case series demonstrates the increased risk and identifies predictors of inpatient mortality among MM patients hospitalized with COVID-19.