Risk stratification for invasive fungal infections in patients with hematological malignancies: SEIFEM recommendations

Pagano, Livio; Busca, Alessandro; Candoni, Anna; Cattaneo, Chiara; Cesaro, Simone; Fanci, Rosa; Nadali, Gianpaolo; Potenza, Leonardo; Russo, Domenico; Tumbarello, Mario; Nosari, Annamaria; Aversa, Franco

doi:10.1016/j.blre.2016.09.002

Cited by 110 publications

(114 citation statements)

References 160 publications

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“…However, myeloid dysfunction alone does not appear to be sufficient to account for ibrutinib‐associated IFD as only a small percentage of the thousands of patients treated with Btk inhibitors have developed this consequence. Multiple predisposing factors have been linked to the development of IFD . The most commonly reported are neutropenia and the use of steroids .…”

Section: Discussionmentioning

confidence: 99%

“…The three patients described in the original report had all received corticosteroids before starting ibrutinib therapy . Other potential contributors include multiple prior treatments, diabetes mellitus, liver disease and for CLL patients—neutropenia, prior IFD, lymphopenia, stage, genetic abnormalities (eg aberrations of the TP53 or ATM genes or trisomy 12) and IgHV mutational status . Chamilos et al proposed there may be a “net state of immunosuppression” which includes factors affecting the adaptive and innate immune system, disease‐related factors, ageing, comorbidities, exposure to fungal conidia, immunosuppressive drugs and possibly a genetic predisposition as contributing to ibrutinib‐associated IFD .…”

Section: Discussionmentioning

confidence: 99%

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Ibrutinib‐associated invasive fungal diseases in patients with chronic lymphocytic leukaemia and non‐Hodgkin lymphoma: An observational study

Ruchlemer

Ben‐Ami

Bar-Meir

et al. 2019

Mycoses

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Summary Background Invasive fungal diseases (IFD) are life‐threatening infections most commonly diagnosed in acute leukaemia patients with prolonged neutropenia and are uncommonly diagnosed in patients with lymphoproliferative diseases. Objectives Following the initial report of aspergillosis diagnosed shortly after beginning ibrutinib for chronic lymphocytic leukaemia, a survey was developed to seek additional cases of IFD during ibrutinib treatment. Methods Local and international physicians and groups were approached for relevant cases. Patients were included if they met the following criteria: diagnosis of chronic lymphocytic leukaemia/non‐Hodgkin lymphoma; proven or probable IFD; and ibrutinib treatment on the date IFD were diagnosed. Clinical and laboratory data were captured using REDCap software. Result Thirty‐five patients with IFD were reported from 22 centres in eight countries: 26 (74%) had chronic lymphocytic leukaemia. The median duration of ibrutinib treatment before the onset of IFD was 45 days (range 1‐540). Aspergillus species were identified in 22 (63%) of the patients and Cryptococcus species in 9 (26%). Pulmonary involvement occurred in 69% of patients, cranial in 60% and disseminated disease in 60%. A definite diagnosis was made in 21 patients (69%), and the mortality rate was 69%. Data from Israel regarding ibrutinib treated patients were used to evaluate a prevalence of 2.4% IFD. Conclusions The prevalence of IFD among chronic lymphocytic leukaemia/non‐Hodgkin lymphoma patients treated with ibrutinib appears to be higher than expected. These patients often present with unusual clinical features. Mortality from IFD in this study was high, indicating that additional studies are urgently needed to identify patients at risk for ibrutinib‐associated IFD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ibrutinib‐associated invasive fungal diseases in patients with chronic lymphocytic leukaemia and non‐Hodgkin lymphoma: An observational study

Ruchlemer

Ben‐Ami

Bar-Meir

et al. 2019

Mycoses

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“…Pagano et al, on behalf of SEIFEM (Sorveglianza Epidemiologica Infezioni Fungine nelle Emopatie Maligne) group, recently published a systematic review of the literature on the risk and incidence of IFIs in the setting of HMs with the aim to consider the main predisposing factors and to suggest practical strategies for prevention and treatment of IFIs 5. In this review, specific IFI predisposing factors are summarized for each disease class.…”

Section: Dear Editormentioning

confidence: 99%

Defining invasive fungal infection risk in hematological malignancies: a new tool for clinical practice

Rambaldi¹,

Russo²,

Pagano

2016

Mediterr J Hematol Infect Dis

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“…Aspergillus spp cause 20%‐30% of all fungal endocarditis cases, while a number of related risk factors have been recognised (cardiac abnormalities, prosthetic valves, malignancy, solid organ transplants, bone marrow transplants, steroid treatment, prolonged antibiotic exposure, haemaotological malignancy, chemotherapy and cytotoxic therapy) . Diagnosis requires a high index of suspicion; blood cultures are almost always negative and fungal vegetations are frequently large.…”

Section: Discussionmentioning

confidence: 99%

Endomyocardial and pericardial aspergillosis in critically ill patients

Dimοpoulos

Frantzeskaki

Kosmopoulos

et al. 2017

Mycoses

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Invasive aspergillosis(IA) is a potentially lethal complication of Aspergillus infection affecting mainly immunocompromised hosts; however, during the last two decades its incidence was increasingly observed in critically ill immunocompetent patients. The objective of this study is to describe the clinical characteristics of histologically proven endomyocardial and pericardial invasion, in the context of IA, in critically ill patients. Eight critically ill patients with histopathological confirmation of endomyocardial/pericardial aspergillosis were evaluated. Risk factors, clinical and laboratory characteristics, treatment, histopathological characteristics and mortality were recorded. Signs and symptoms of cardiac dysfunction were not observed in any of the patients. Therapy was administered to six of them shortly after the first positive culture. The observed histopathological lesions included haemorrhagic lesions, small vessels with central thrombosis and surrounding consolidated tissue with necrosis. Voriconazole, caspofungin, lipid amphotericin B and itraconazole were the used antifungals. The mortality rate was high (87.5%). Endomyocardial and pericardial aspergillosis are devastating complications of invasive aspergillosis. Clinical suspicion is low making the diagnosis difficult, therefore histopathological examination of tissues are required. The mortality is high.

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Risk stratification for invasive fungal infections in patients with hematological malignancies: SEIFEM recommendations

Cited by 110 publications

References 160 publications

Ibrutinib‐associated invasive fungal diseases in patients with chronic lymphocytic leukaemia and non‐Hodgkin lymphoma: An observational study

Ibrutinib‐associated invasive fungal diseases in patients with chronic lymphocytic leukaemia and non‐Hodgkin lymphoma: An observational study

Defining invasive fungal infection risk in hematological malignancies: a new tool for clinical practice

Endomyocardial and pericardial aspergillosis in critically ill patients

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