Hepatosplenic Candidiasis in Patients with Acute Leukemia: Incidence and Prognostic Implications

Abstract

We studied the incidence among, risk factors for, and survival of adult patients with acute leukemia and hepatosplenic candidiasis during the period 1980 to 1993. Of 562 adult patients with acute leukemia, 38 (6.8%) had hepatosplenic candidiasis. The incidence of infection increased fivefold during the study period. The incidence was higher among patients with acute lymphatic leukemia (11.3%) than among those with acute myeloid leukemia (5.1%) (P = .01). The median survival was 9.5 months, and by the end of follow-up, 74% of patients had died. Patients whose leukemia was in remission before the last cytotoxic treatment preceding hepatosplenic candidiasis survived longer than did patients with newly diagnosed or refractory or relapsed leukemia (P = .0065). Eleven patients died within 3 months after the diagnosis of the infection: 7 of 16 with newly diagnosed leukemia, 4 of 10 with refractory or relapsed leukemia, and 0 of 12 with leukemia in remission (P = .028). In all of the patients who died within 3 months, infection was found at autopsy. In conclusion, the incidence of hepatosplenic candidiasis has significantly increased since 1980, and the outcome for patients with this infection is related to the stage of leukemia.

Common polymorphisms in critical genes of innate immunity do not contribute to the risk for chronic disseminated candidiasis in adult leukemia patients

“…Demographic and clinical data have been previously reported elsewhere [1]. The overall distribution of age, sex and underlying diseases was similar between cases and controls.…”

“…It is possible that the relatively small number of cases and controls could have undermined this pilot study, but it is important to note that the study was conducted on the largest study assembled to date [1,11]. Our data did not demonstrate significant genetic risk factors for susceptibility to chronic disseminated candidiasis in the adult leukemia patients.…”

“…The study population was composed of adult patients with acute leukemia who were recruited in the Department of Medicine, Helsinki University Central Hospital, Helsinki, during the period 1980 Á/1998 [1,11]. Demographic and clinical data have been previously reported elsewhere [1].…”

Treatment of invasive fungal infections in cancer patients—Recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)

“…Treatment experience is mainly available for D-AmB and fluconazole, showing response rates of more than 50% of cases [1,3,15,21,74,98], but caspofungin is today accepted as alternative therapy when the Candida species is not identified [77,105]. If Candida spp.…”

The Liver Prometastatic Reaction of Cancer Patients: Implications for Microenvironment-Dependent Colon Cancer Gene Regulation

“…While this local immune suppression can provide a favorable milieu for liver transplantation [47] and increases oral tolerance [48], it may also contribute to the occurrence of autoimmunity, infectious diseases and cancer metastasis in this organ [49]. Not surprisingly, the hepatic microenvironment can be relatively tolerant to invading microorganisms such as malaria sporozoites [50] and fungi [51] and is also favorable to the development of hepatic metastases.…”