scholarly journals Infections in Patients with Hematological Cancer: Recent Developments

Hematology ◽  
2003 ◽  
Vol 2003 (1) ◽  
pp. 438-472 ◽  
Author(s):  
Susan N. O’Brien ◽  
Nicole M.A. Blijlevens ◽  
Tahsine H. Mahfouz ◽  
Elias J. Anaissie
Keyword(s):  
T Cell ◽  
Fungal Infections ◽  
Bone Marrow Involvement ◽  
Mucosal Damage ◽  
Invasive Fungal Infections ◽  
Mucosal Barrier ◽  
Treatment And Prevention ◽  
Hematologic Cancer ◽  
Recent Developments ◽  
Pathological Model

Abstract One of the most common complications involved in treating patients with hematologic cancer is infection. In many cases there are multiple factors that predispose these patients to infections such as neutropenia induced by therapy or bone marrow involvement, hypogammaglobulinemia, T-cell dysfunction, and mucosal damage. In addition, newer therapies have changed the spectrum of infection that is seen in these patients. In Section I, Dr. Blijlevens discusses mucosal damage as a major risk factor for complications of cytotoxic chemotherapy. She focuses on mucosal barrier injury (MBI) as manifest in the GI tract and will describe a pathological model to explain MBI, evaluate risk factors for development of this syndrome, explain the relationship between MBI and infection, and discuss treatment and prevention of this injury. Invasive fungal infections continue to represent a significant problem in patients with hematologic cancer. In Section II, Drs. Anaissie and Mahfouz review the latest developments in the diagnosis, prevention, and management of invasive fungal infections with a focus on a risk-adjusted approach to this problem. Finally, in Section III, Dr. O’Brien reviews infections associated with newer therapeutic regimens in hematologic cancers. The spectrum of infections has changed with the use of purine analogs and the advent of monoclonal antibodies. The profound T-cell suppression associated with these therapies has led to the emergence of previously rare infections such as cytomegalovirus. An approach to both prophylaxis and management of these infections is discussed.

scholarly journals Invasive Fungal Infections after Anti-CD19 Chimeric Antigen Receptor-Modified T-Cell Therapy: State of the Evidence and Future Directions

2021 ◽  
Vol 7 (2) ◽  
pp. 156
Author(s):  
Will Garner ◽  
Palash Samanta ◽  
Ghady Haidar
Keyword(s):  
Risk Factors ◽  
T Cell ◽  
Cell Therapy ◽  
Chimeric Antigen Receptor ◽  
Fungal Infections ◽  
Antigen Receptor ◽  
Invasive Fungal Infections ◽  
T Cell Therapy ◽  
Car T Cell ◽  
Car T

Studies describing invasive fungal infections (IFIs) after chimeric antigen receptor-modified T-cell (CAR-T-cell) therapy are limited. Although post-CAR-T-cell IFIs appear to be uncommon, they are associated with significant morbidity and mortality. Specific risk factors for IFIs in CAR-T-cell recipients have not been fully characterized and are often extrapolated from variables contributing to IFIs in patients with other hematologic malignancies or those undergoing hematopoietic cell transplant. Optimal prophylaxis strategies, including the use of yeast versus mold-active azoles, also remain ill-defined. Further research should investigate key risk factors for IFIs and establish an evidence-based approach to antifungal prophylaxis in these patients in order to improve clinical outcomes.

scholarly journals Current Status of Nonculture Methods for Diagnosis of Invasive Fungal Infections

2002 ◽  
Vol 15 (3) ◽  
pp. 465-484 ◽  
Author(s):  
Siew Fah Yeo ◽  
Brian Wong
Keyword(s):  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Diagnostic Methods ◽  
Current Status ◽  
Course Of Disease ◽  
Host Immune Responses ◽  
Appropriate Treatment ◽  
Recent Developments ◽  
Timely Fashion ◽  
Fungal Antigens

SUMMARY The incidence of invasive fungal infections has increased dramatically in recent decades, especially among immunocompromised patients. However, the diagnosis of these infections in a timely fashion is often very difficult. Conventional microbiologic and histopathologic approaches generally are neither sensitive nor specific, and they often do not detect invasive fungal infection until late in the course of disease. Since early diagnosis may guide appropriate treatment and prevent mortality, there has been considerable interest in developing nonculture approaches to diagnosing fungal infections. These approaches include detection of specific host immune responses to fungal antigens, detection of specific macromolecular antigens using immunologic reagents, amplification and detection of specific fungal nucleic acid sequences, and detection and quantitation of specific fungal metabolite products. This work reviews the current status and recent developments as well as problems in the design of nonculture diagnostic methods for invasive fungal infections.

Invasive fungal infections are associated with severe depletion of circulating RANTES

2005 ◽  
Vol 54 (11) ◽  
pp. 1017-1022 ◽  
Author(s):  
Michael Ellis ◽  
Basel al-Ramadi ◽  
Ulla Hedström ◽  
Hussain Alizadeh ◽  
Victor Shammas ◽  
...  
Keyword(s):  
T Cell ◽  
Fungal Infection ◽  
Invasive Fungal Infection ◽  
Host Response ◽  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Time Of Death ◽  
Haematological Malignancies ◽  
Platelet Counts ◽  
The Mean

Serum RANTES (regulated on activation, normal T-cell expressed and secreted) concentrations were measured in 14 patients who had haematological malignancies and developed invasive fungal infections (three of them definite, eight probable and three possible). RANTES levels fell substantially from pre-chemotherapy values at the start of and throughout the fungal infection, and recovered in patients who survived the fungal infection. However, in patients who died from the invasive fungal infection, RANTES levels did not recover. For survivors the mean ± sd levels for RANTES were 7656 ± 877 pg ml−1 on the day prior to chemotherapy, 3723 ± 2443 pg ml−1 on the first day of fungal infection diagnosis (significantly different from baseline; P = 0.001) and 9078 ± 2256 pg ml−1 at recovery from the fungal infection (significantly different from lowest value; P < 0.0001). Platelet counts were closely correlated with the RANTES levels (r = 0.63, P < 0.001). The RANTES concentrations for the three patients who died were similar to those who survived at all equivalent timepoints, but were significantly lower at the time of death (792 ± 877) compared to the values at recovery for survivors (P = 0.005). The finding that patients who died from an invasive fungal infection had very low platelet counts and RANTES concentrations suggests that these could play a role in host response to such infections.

scholarly journals Assessment of the Role of 1,3-β-d-Glucan Testing for the Diagnosis of Invasive Fungal Infections in Adults

2021 ◽  
Vol 72 (Supplement_2) ◽  
pp. S102-S108
Author(s):  
F Lamoth ◽  
H Akan ◽  
D Andes ◽  
M Cruciani ◽  
O Marchetti ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Organ Transplant ◽  
Invasive Fungal Infections ◽  
Clinical Settings ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Hematologic Cancer ◽  
Pretest Likelihood ◽  
Solid Organ Transplant Recipients

Abstract Detection of 1,3-β-d-glucan (BDG) in serum has been evaluated for its inclusion as a mycological criterion of invasive fungal infections (IFI) according to EORTC and Mycoses Study Group (MSG) definitions. BDG testing may be useful for the diagnosis of both invasive aspergillosis and invasive candidiasis, when interpreted in conjunction with other clinical/radiological signs and microbiological markers of IFI. However, its performance and utility vary according to patient population (hematologic cancer patients, solid-organ transplant recipients, intensive care unit patients) and pretest likelihood of IFI. The objectives of this article are to provide a systematic review of the performance of BDG testing and to assess recommendations for its use and interpretation in different clinical settings.

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