Filamentous Fungi Infection in Patients with Myelodysplastic Syndrome. A Report of Twelve Cases

Abstract

In this report we analyse the risk factors, the clinical characteristics and outcome of patients with myelodysplastic syndrome (MDS) who developed an Invasive Fungi Infection (IFI). This was a multicentric study involving 14 Italian Haematological Divisions during a 10-year period whose object was to identify the characteristics of patients with this infection. The study recorded 391 consecutive documented IFI, 12 of which (3%) occurred in MDS patients, from 5 of the participating centres. The primary localization of infection was lung in 10 cases and skin and paranasal sinus in 1 case each. Ten patients died at the end of follow up. The death was mainly attributable to IFI progression in nine of them. The factors that appeared related to an unfavourable outcome were intensive chemotherapy within 30 days before IFI diagnosis, presence of multiple localization at chest X-ray in patients with isolated pulmonary IFI and multiple sites of infection.

Infections in Myelodysplastic Syndrome in Relation to Stage and Therapy

“… 70 – 74 It is noteworthy that most of the fungal infections are reported in MDS patients with high blasts infiltration treated with intensive chemotherapy. 75 So the experiences with intensive therapy of patients with MDS or AML are frequently reported together, furthermore, before the WHO classification of 2008, the subjects with blast infiltration between 20 and 30% were classified in the MDSs. 76 However, the rate of the relapse of patients with MDS was very high, so, similarly to leukemia, trials were made utilizing intensive chemotherapy as a pre-transplant procedure followed by an allogeneic hematopoietic stem cell transplant (HSCT) 70 , 77 However, the pretreatment with high dose chemotherapy of patients with MDS entails a series of side effects, among them, infections are prevalent, which reduce the number of patients susceptible to stem cell transplantations.…”