Abstract
Objective
The survival benefit of combination antifungal therapy for Invasive mucormycosis (IM) in patients with hematologic malignancy (HM) and hematopoietic cell transplant (HCT) is not well defined.
Patients and Methods
This multicenter, retrospective study included HM and HCT recipients with proven or probable IM between Jan 1, 2007-Dec 31, 2017 from ten transplant centers across North America.
Results
Sixty-four patients with proven (n = 47) or probable (n = 17) IM defined by 2008 EORTC/MSG consensus definitions were included. Thirty-nine (61%) were HCT recipients (95% allogeneic). Sites of infection included rhino-orbital-cerebral (33), pulmonary (30%), disseminated (19%), gastrointestinal (3%) and cutaneous (3%). Surgical debridement was performed in 66%. Initial antifungal treatment consisted of: AmB alone (44%), AmB + posaconazole (25%), AmB + echinocandin (13%), AmB + isavuconazole (8%), posaconazole alone (5%), and isavuconazole alone (3%). All-cause mortality at 30-days and 1-year were 38% and 66%, respectively. Initial treatment with AmB plus posaconazole or isavuconazole (n=28) was associated with a trend toward lower treatment failure compared to AmB (n=21) (42% vs. 64%, p=0.136)
Conclusions
Long-term survival with IM among HM and HCT populations remains poor. However, initial use of AmB + azole in conjunction with surgery may result in less treatment failure. More evidence from prospective controlled studies is needed to confirm this observation.
Human metapneumovirus infections in hematopoietic cell transplant recipients and hematologic malignancy patients: A systematic review
