Risk factors and impact of non-Aspergillus mold infections following allogeneic HCT: a CIBMTR infection and immune reconstitution analysis

Riches, Marcie L.; Trifilio, Steven; Chen, Min; Ahn, Kwang Woo; Langston, Amelia; Lazarus, Hillard M.; Marks, David I.; Martino, Rodrigo; Maziarz, Richard T.; Papanicolou, G. A.; Wingard, John R.; Young, Jo Anne H.; Bennett, Charles L.

doi:10.1038/bmt.2015.263

Cited by 31 publications

(32 citation statements)

References 25 publications

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“…In fact, IMD (either IA or non‐ Aspergillus IMD) were identified as the most significant independent predictor of mortality in this series. Indeed, our 12‐week mortality rates among patients with IA and non‐ Aspergillus IMD were comparable, which is in contrast to 12‐week mortality rates between 17% and 35.5% reported in clinical trials of IA during the last decade but comparable to those of non‐ Aspergillus IMD . It remains unclear why such high mortality was observed among patients with IA in our cohort.…”

Section: Discussioncontrasting

confidence: 64%

Incidence and outcome of invasive fungal diseases after allogeneic hematopoietic stem cell transplantation: A Swiss transplant cohort study

Kuster

Stampf

Gerber

et al. 2018

Transplant Infectious Dis

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Contemporary, comprehensive data on epidemiology and outcomes of invasive fungal disease (IFD) including breakthrough IFD among allogeneic hematopoietic stem cell transplantation (HSCT) recipients are scarce. We included 479 allogeneic HSCT recipients with 10 invasive candidiasis (IC) and 31 probable/proven invasive mold disease (IMD) from the Swiss Transplant Cohort Study from 01.2009 to 08.2013. Overall cumulative incidence was 2.3% for IC and 8.5% for probable/proven IMI: 6% for invasive aspergillosis (IA) and 2.5% for non-AspergillusIMI. Among 41 IFD, 46% IFD were breakthrough, with an overall incidence of 4.6%, more frequently caused by other-than-Aspergillus fumigatus molds than primary IFD (47.6% (10/21) vs 13% (3/23), P = 0.04). Twelve-week mortality among patients with IC was 20% and 58.6% for probable/proven IMD (60% IA and 54.6% non-Aspergillus). Our results reveal that breakthrough IFD represent a marked burden of probable/proven IFD postallogeneic HSCT and mortality remains above 50% in patients with probable/proven IMD, underscoring the ongoing challenges to prevent and treat IFD in these patients.

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Section: Discussioncontrasting

confidence: 64%

Incidence and outcome of invasive fungal diseases after allogeneic hematopoietic stem cell transplantation: A Swiss transplant cohort study

Kuster

Stampf

Gerber

et al. 2018

Transplant Infectious Dis

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“…In a recent large study reviewing cases of non-Aspergillus invasive mold infections in allogeneic HSCT recipients, the overall incidence rate was only 1% (124 cases/11,980 patients) for development of infection within 1 year of the transplant. The overall mortality within 1 year of transplant was 78%, which has not changed significantly from rates of 80% reported in the 1990s (65,66). Mucormycosis infections occur more commonly in the preengraftment period, although higher mortality is associated with infections occurring in the late postengraftment period (Fig.…”

Section: Fungal Infectionsmentioning

confidence: 74%

“…Other significant mold pathogens in transplant patients include Fusarium species and Scedosporium species. Risk factors for these infections include umbilical cord blood transplants and prior CMV infection for Fusarium (Table 1) (65,67).…”

Section: Fungal Infectionsmentioning

confidence: 99%

Laboratory Diagnosis of Infections in Cancer Patients: Challenges and Opportunities

Babady

2016

J Clin Microbiol

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Infections remain a significant cause of morbidity and mortality in cancer patients. The differential diagnosis for these patients is often wide, and the timely selection of the right clinical tests can have a significant impact on their survival. However, laboratory findings with current methodologies are often negative, challenging clinicians and laboratorians to continue the search for the responsible pathogen. Novel methodologies are providing increased sensitivity and rapid turnaround time to results but also challenging our interpretation of what is a clinically significant pathogen in cancer patients. This minireview provides an overview of the most common infections in cancer patients and discusses some of the challenges and opportunities for the clinical microbiologist supporting the care of cancer patients. Cancer is the leading cause of death worldwide, with 8.2 million deaths reported worldwide in 2012 (1). Common treatment options for oncology patients include hematopoietic stem cell transplantation (HSCT), chemotherapeutic drugs, and surgical resection. The first successful HSCT was performed in 1959 by E. Donall Thomas in Cooperstown, NY, with infusion of two acute lymphocytic leukemia (ALL) patients with bone marrow from their disease-free identical twins. Although initially successful, their remission was short-lived, with recurrence of the disease occurring within a few months of the transplant (2). Today, HSCT is a curative therapy for many types of hematologic malignancies and immune deficiency diseases. E. Donall Thomas and Joseph E. Murray received the 1991 Nobel Prize in Physiology or Medicine for their discoveries concerning "organ and cell transplantation in the treatment of human disease."Of note for microbiologists, the history of cancer chemotherapy started as a history of antibiotics with Paul Ehrlich's discovery in 1909 of arsphenamine (Salvarsan), the first effective treatment against Treponema pallidum infection. Paul Ehrlich also evaluated early versions of alkylating agents to treat cancer but with little hope that these drugs would be curative. Decades of investigations and trials have resulted in the current modern chemotherapeutic agents that are curative for large groups of either hematologic malignancies or solid tumors when used in conjunction with surgical resection (3). CANCER AND INFECTIONSInfections remains a significant cause of death in cancer patients, particularly in HSCT recipients (1). Susceptibility to infections is related to a host's ability to reconstitute their immune system following HSCT and/or chemotherapy treatment. The longer it takes a patient to recover, the higher at risk they are of developing infections. In general, the highest risk of infections occurs in allogeneic HSCT recipients and leukemia patients, and the lowest risk occurs in solid-tumor patients on standard chemotherapy (Table 1) (4). The posttransplant period may be divided into three stages: preengraftment (less than 4 weeks), early postengraftment (3 weeks to 3 months), and late poste...

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“…Aspergillus and other mold infections such as zygomycosis and fusariosis occur predominantly in patients with deficiencies in innate and adaptive immunity that place them at risk for infection [40]. Patients with prolonged (>10 days) neutropenia (<500 cells/μL) are commonly at the highest risk of mold infections [41], which may affect the lungs, sinuses, and soft tissues [41, 42].…”

Section: Fungal Diseases In Immunocompromised Hostsmentioning

confidence: 99%

Use of Fungal Diagnostics and Therapy in Pediatric Cancer Patients in Resource-Limited Settings

Mukkada

Kirby

Apiwattanakul

et al. 2016

Curr Clin Micro Rpt

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Fungal diseases are an important cause of mortality in immunocompromised hosts, and their incidence in pediatric cancer patients in low- to middle-income countries is underestimated. In this review, we present relevant, up-to-date information about the most common opportunistic and endemic fungal diseases among children with cancer, their geographic distribution, and recommended diagnostics and treatment. Efforts to improve the care of children with cancer and fungal disease must address the urgent need for sustainable and cost-effective solutions that improve training, fungal disease testing capability, and the use of available resources. We hope that the collective information presented here will be used to advise healthcare providers, regional and country health leaders, and policymakers of the current challenges in diagnosing and treating fungal infections in children with cancer in low- to middle-income countries.

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Risk factors and impact of non-Aspergillus mold infections following allogeneic HCT: a CIBMTR infection and immune reconstitution analysis

Cited by 31 publications

References 25 publications

Incidence and outcome of invasive fungal diseases after allogeneic hematopoietic stem cell transplantation: A Swiss transplant cohort study

Incidence and outcome of invasive fungal diseases after allogeneic hematopoietic stem cell transplantation: A Swiss transplant cohort study

Laboratory Diagnosis of Infections in Cancer Patients: Challenges and Opportunities

Use of Fungal Diagnostics and Therapy in Pediatric Cancer Patients in Resource-Limited Settings

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