Epidemiology of invasive fungal disease in lymphoproliferative disorders

Abstract

ous oral chemotherapy in myeloma cohort, IFD rate per 10,000 treatment days not provided. © F e r r a t a S t o r t i F o u n d a t i o nhaematologica 2015; 100:e463 Table 2. Characteristics of patients with lymphoproliferative disorders with invasive fungal disease (2009)(2010)(2011) LETTERS TO THE EDITOR © F e r r a t a S t o r t i F o u n d a t i o nFluconazole and mold-active antifungal prophylaxis were administered to 287/773 (37.1%) and 38/773 (4.9%) patients, respectively. Patients with precursor lymphoid neoplasms had the highest prevalence of IFD (5/17; 29.4%, 95% CI 9.5-68.6%), followed by patients with mature B-cell neoplasms-CLL/SLL (4/51; 7.8%, 95% CI 2.1-20.1%), DLBCL (8/186; 4.3%, 95% CI 1.9-8.5%) and plasma cell neoplasms (7/251; 2.8%, 95% CI 1.1-5.7%). IFD events per treatment days demonstrated a similarly larger relative burden of disease in patients with precursor lymphoid neoplasms (10.7 IFD per 10,000 treatment days) ( Table 1). Mold-active antifungal prophylaxis was used in 52.9% of patients with precursor lymphoid neoplasms. Of the five patients with precursor lymphoid neoplasms who developed IFD, three had received fluconazole prophylaxis, one had received posaconazole prophylaxis and one received no antifungal prophylaxis. IFD was observed to occur at different treatment stages of disease, and these are summarized in Table 2.Aspergillus species was the most frequently identified fungal pathogen (13 cases) (cultured in 7 cases; detected on PCR in 8 cases). Other fungal pathogens, in order of reducing frequency included Candida (5 cases), Scedosporium (1 case), Scopulariopsis (1 case) and Cryptococcus (1 case) species. The pulmonary system (19 cases) was the most common site of IFD, followed by blood (5 cases), sinus (2 cases), soft tissue/viscera (2 cases) and central nervous system (1 case). Of the 29 patients treated for IFD, 12 (41.4%) required admission to the intensive care unit and 30-day all-cause mortality was 31.0% (9/29).IFD is an important and potentially modifiable cause of morbidity and mortality in patients with lymphoproliferative disorders receiving chemotherapy. Few studies have described the epidemiology and treatment outcome of IFD in these patients and none has incorporated all of the current diagnostic strategies available (e.g. Aspergillus PCR, galactomannan and FDG PET/CT diagnostics). Our study identified an overall IFD prevalence of 3.8% with cases occurring in all disease subsets except mature Tand NK-cell lymphoma. The prevalence of IFD was highest in patients with precursor lymphoid neoplasms (29.4%). This occurred despite 52.9% of patients receiving mold-active prophylaxis. This finding is consistent with a 28% incidence reported at another Australian center 8 and may be attributed to the increasing intensity of induction chemotherapy protocols for lymphoblastic haematologica 2015; 100:e465 R: rituximab; CVP:cyclophosphamide/vincristine/prednisolone; bortez: bortezomib; dex: dexamethasone; thal: thalidomide; len: lenalidomide; bleomycin, vincristine, etopo...

Invasive fungal infections in chronic lymphoproliferative disorders: a monocentric retrospective study

“…An increased risk of severe infection has been described in MM patients treated with bortezomib and in advanced stage HL treated with the intensified bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP) regimen. 6 The 3.2% incidence of IFIs in our series is in line with recent reports from the literature: 3% in the study by Nosari et al 2 and 3.8% in the study from Teng et al, 3 even if in the latter study both possible IFIs and precursor lymphoid neoplasms were included. This incidence is higher compared to the report of SEIFEM-2004 (NHL 1.6%, HL 0.7%, MM 0.5%, CLL 0.5%), 1 which registered IFIs in the years from 1999 to 2003.…”

Infection is an Independent Predictor of Death in Diffuse Large B Cell Lymphoma

“…Fungal infections accounted for 19% of infections, which is substantially higher than in other literature 17 . In this study, 2.5% had Pneumocystis jirovecci , which is below the 3.5% rate for which prophylaxis is recommended according to Australian national consensus guidelines 18 .…”

Primary prophylaxis of invasive fungal infections in patients with haematological malignancies: 2017 update of the recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society for Haematology and Medical Oncology (DGHO)

“…Invasive fungal infections (IFIs) cause substantial morbidity and mortality in patients with haematological malignancies, especially in those receiving remission-induction therapy for acute myeloid leukaemia (AML) or myelodysplastic syndrome (MDS) and allogeneic haematopoietic stem cell transplantation (HSCT) [ 53 , 97 ]. In addition, the increasing use of new immune modulating drugs in cancer therapy has opened up an entirely new spectrum of patients at risk [ 57 , 84 ].…”