Epidemiology of Invasive Fungal Diseases in Patients with Hematologic Malignancies and Hematopoietic Cell Transplantation Recipients Managed with an Antifungal Diagnostic Driven Approach

Abstract

Patients with hematologic malignancies and hematopoietic cell transplant recipients (HCT) are at high risk for invasive fungal disease (IFD). The practice of antifungal prophylaxis with mold-active azoles has been challenged recently because of drug–drug interactions with novel targeted therapies. This is a retrospective, single-center cohort study of consecutive cases of proven or probable IFD, diagnosed between 2009 and 2019, in adult hematologic patients and HCT recipients managed with fluconazole prophylaxis and an antifungal diagnostic-driven approach for mold infection. During the study period, 94 cases of IFD occurred among 664 hematologic patients and 316 HCT recipients. The frequency among patients with allogeneic HCT, autologous HCT, acute leukemia and other hematologic malignancies was 8.9%, 1.6%, 17.3%, and 6.4%, respectively. Aspergillosis was the leading IFD (53.2%), followed by fusariosis (18.1%), candidiasis (10.6%), and cryptococcosis (8.5%). The overall 6-week mortality rate was 37.2%, and varied according to the host and the etiology of IFD, from 28% in aspergillosis to 52.9% in fusariosis. Although IFD occurred frequently in our cohort of patients managed with an antifungal diagnostic driven approach, mortality rates were comparable to other studies. In the face of challenges posed by the use of anti-mold prophylaxis, this strategy remains a reasonable alternative.

Epidemiology and Factors Associated with Treatment Success of Invasive Fungal Infections Among Newly Hematologic Malignancy Patients Receiving Chemotherapy or Hematopoietic Stem Cell Transplant in Thailand

“… 12 The survival rate within 12 weeks was high in our study (73.8%) when compared to previous studies that reported a survival rate of about 60%. 2 , 5 , 21 , 22 Our mortality rate was 26.2% which lower than that reported in prior retrospective cohort studies in Thailand. 5 Our finding suggested that the accessibility of novel antifungal drugs and novel diagnostic tools in recent years may improve the survival outcome of patients.…”

“…The epidemiology of IFI in patients with HM has also changed recently. Its incidence varies among different regions, ranging 4.6%–15% in Europe, 2 , 15–19 9.6% to 16.2% in South Africa, 20 , 21 and 1.3% to 12% in Asia. 3 , 5 , 22–24 In our study, the incidence of IFI among patients with HM was lower than that reported in the past decade in Thailand (14%).…”

“…This result indicates that PAP represents an effective and reasonable approach for reducing the incidence of IFI in patients with HM, as previously reported. 21 , 27–29 …”

Invasive Fusariosis in Patients with Hematologic Diseases

“…As shown in Table 2, the incidence of invasive fusariosis in patients with hematologic diseases varies across different regions of the globe with the highest incidence reported in Brazil, compared with other countries such as Italy, USA, and Spain [1,12,[28][29][30][31][32][33][34][35].…”

High-Risk Neutropenic Fever and Invasive Fungal Diseases in Patients with Hematological Malignancies

“…The most frequently identified fungal pathogens are Aspergillus spp. and Candida spp., which significantly contribute to mortality in these patients [ 2 , 3 , 4 , 5 , 6 ]; therefore, mold-active antifungal prophylaxis (MAP) has been established as a standard of care [ 7 , 8 , 9 , 10 , 11 , 12 ]. However, breakthrough IFDs (b-IFDs) in patients receiving antifungal prophylaxis (AFP), including MAP, is an issue for clinicians, alongside with the rising resistance to antifungals and the continuous change in IFD epidemiology, due to both the increased use of mold-active drugs and the improved survival of HM patients.…”