Successful treatment of Trichosporon fungemia in a patient with refractory acute myeloid leukemia using voriconazole combined with liposomal amphotericin B

Abstract

Trichosporon fungemia is a rare and fatal fungal infection that occurs in patients with prolonged neutropenia associated with hematologic malignancies. A 21-year-old male developed Trichosporon fungemia during remission induction therapy for acute myeloid leukemia (AML). Although two courses of induction therapy failed to induce a remission of AML, combination therapy with voriconazole and liposomal amphotericin B (L-AmB) followed by monocyte colony-stimulating factor ameliorated the Trichosporon fungemia and enabled the patient to receive reduced-intensity bone marrow transplantation (BMT) from his human leukocyte antigen-A one-locus mismatched mother. The patient achieved a durable remission after BMT without exacerbation of Trichosporon fungemia. The combination therapy with voriconazole and L-AmB may therefore be useful in controlling Trichosporon fungemia associated with prolonged neutropenia after remission induction therapy for AML.

Trichosporon faecale invasive infection in a patient with severe aplastic anemia: Efficacy of voriconazole and liposomal amphotericin B before neutrophil recovery

“…In that study, resolution of infection was significantly associated with neutrophil recovery [3] . Hosokawa K et al reported in 2011 on a patient recovering from Trichosporon asahii fungemia before neutrophil recovery after a combination therapy with voriconazole and liposomal amphotericin B, as in our case [16] . The patient eventually died of acute myeloid leukemia but the combination therapy was effective enough to allow subsequent chemotherapies and allogeneic stem cell transplantations [16] .…”

“…Hosokawa K et al reported in 2011 on a patient recovering from Trichosporon asahii fungemia before neutrophil recovery after a combination therapy with voriconazole and liposomal amphotericin B, as in our case [16] . The patient eventually died of acute myeloid leukemia but the combination therapy was effective enough to allow subsequent chemotherapies and allogeneic stem cell transplantations [16] . Trichosporon faecale is rarely reported in humans and almost always in localized infections [1,5,8–10] .…”

ESCMID and ECMM joint clinical guidelines for the diagnosis and management of rare invasive yeast infections

“…However, variations in susceptibility in vitro may suggest that not all species and isolates are equally susceptible to this agent [257]. Voriconazole is the preferred agent because it displays good in vitro activity against most Trichosporon species and isolates and has been associated with good in vivo outcome in most cases of clinical and animal studies [232,233,256,261,263,[269][270][271]. In addition to triazole treatment, resolution of myelosuppression and removal of vascular catheters are other confounders related with increased survival [28,192,231,237,238].…”

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

“…As high MIC values correspond to low response rates in hematological patients receiving amphotericin B [51] or an echinocandin [17, 53, 105], these agents cannot be recommended as monotherapy (DIII). Clinical data to recommend these agents in combination therapy with each other or with an azole are too scarce to establish any recommendation [14, 51, 71]. …”