Abstract
Antifungal therapy may be unable to eradicate invasive mycosis in leukemia patients. The presence of persisting pulmonary nodules owing to mycosis seems to increase the risk of fungal relapse after chemotherapy and transplant procedures. Between 1997 and 2004, 10 acute leukemia patients underwent pulmonary surgery for invasive mycosis. The median time from diagnosis of mycosis to surgery was 135 days (range 21–147). Three patients underwent emergency surgery, owing to hemoptysis. In the other seven patients with nodule/cavitation remaining after antifungal treatment, surgery (three wedge resections, four lobectomies) was scheduled before transplant. Pathologic examination confirmed two aspergillosis and three zygomycosis. The only side effect was pneumothorax in one case. Nine patients were considered cured. Six patients underwent bone marrow transplantation (three allogeneic, three autologous) with antifungal prophylaxis without relapse during the transplant procedure. In selected patients scheduled for bone marrow transplantation, surgical resection of localized pulmonary fungus nodules combined with antifungal prophylaxis seem to be an effective treatment for preventing mycotic relapse.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
McNeil MM, Nash SL, Hajjek RA, Phelam MA, Conn LA, Plikaytis BD et al. Trends in mortality due to invasive mycotic disease in United States, 1980–1997. Clin Infect Dis 2001; 33: 641–647.
Lin SJ, Schranz J, Teutsch SM . Aspergillosis case-fatality rate: systematic review of the literature. Clin Infect Dis 2001; 32: 358–366.
Marr K, Lavardiere M, Gugel A, Leinsering W . Antifungal therapy decreases sensitivity of the Aspergillus galactomannan enzyme immunoassay. Clin Infect Dis 2005; 40: 1762–1769.
Jantunen E, Ruutu P, Piilonen A, Volin L, Parkkali T, Ruutu T . Treatment and outcome of invasive Aspergillus infections in allogeneic BMT recipients. Bone Marrow Trasplant 2000; 26: 759–762.
Sipsas NK, Kontoyiannis DP . Clinical issues regarding relapsing aspergillosis and the efficacy of secondary antifungal prophylaxis in patients with hematological malignancies. Clin Infect Dis 2006; 42: 1584–1591.
Kibbler CC, Milkins SR, Bahamra A, Spiteri MA, Noone P, Prentice HG . Apparent pulmonary mycetoma following invasive aspergillosis in neutropenic patients. Thorax 1988; 43: 108–112.
Pagano L, Ricci P, Nosari A, Tonso A, Buelli M, Montillo M et al. Fatal haemoptysis in pulmonary filamentous mycosis: an underevaluated cause of death in patients with acute leukemia in hematological complete remission. A retrospective study and review of literature. Br J Haematol 1995; 89: 500–505.
Meyers JD . Fungal infections in bone marrow transplant patients. Semin Oncol 1990; 17: 10–13.
Todeschini G, Murari C, Bonesi R, Zizzolo G, Verlato G, Tecchio C et al. Invasive aspergillosis in neutropenic patients: rapid neutrophil recovery is a risk factor for severe pulmonary complications. Eur J Clin Invest 1999; 29: 453–457.
Avivi I, Oren I, Haddad N, Rowe JM, Dann EJ . Stem cell transplantation post invasive fungal infection is a feasible task. Am J Hematol 2004; 75: 6–11.
Martino R, Subira M, Rovira M, Solano C, Vasquez L, Sanz GF et al. Invasive fungal infections after allogeneic peripheral blood stem cell transplantation: incidence and risk factors in 395 patients. Br J Haematol 2002; 116: 475–482.
Marr KA, Carter RA, Boeckh M, Martin P, Corey L . Invasive aspergillosis in allogeneic stem cell transplant recipients: changes in epidemiology and risk factors. Blood 2002; 100: 4358–4366.
Ascioglu S, Rex JH, de Paw B, Bennett JE, Bille J, Crokaert F et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 2002; 34: 7–14.
Denning DW, Marinus A, Cohen J, Spence D, Herbrecht R, Pagano L et al. An EORTC multicentre prospective survey of invasive aspergillosis in haematological patients: diagnosis and therapeutic outcome. EORTC Invasive Fungal Infections Cooperative Group. J Infect 1998; 37: 173–180.
Pagano L, Caira M, Candoni A, Offidani A, Fianchi L, Martino B et al. The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica 2006; 91: 1068–1075.
Pagano L, Girmenia C, Mele L, Ricci P, Tosti ME, Nosari A et al. Infections caused by filamentous fungi in patients with hematologic malignancies. A report of 391 cases by GIMEMA Infection Program. Haematologica 2001; 86: 862–870.
Caillot D, Casasnovas O, Bernard A, Couaillier GF, Durand C, Cuisenier B et al. Improved management of invasive pulmonary aspergillosis in neutropenic patients using early thoracic computed tomography scan and surgery. J Clin Oncol 1997; 15: 139–147.
Hoover M, Morgan ER, Kletzel M . Prior fungal infection is not a contraindication to bone marrow transplant in patients with acute leukemia. Med Pediatr Oncol 1997; 28: 268–273.
Wang JT, Yao M, Tang JL, Chang SC, Hung CC . Prior invasive fungal infection is not a contraindication to subsequent allogeneic bone marrow transplantation in adult patients with hematologic malignancies. J Clin Oncol 2001; 19: 4000–4001.
Cordonnier C, Maury S, Pautas C, Bastie JN, Chehata S, Castaigne S et al. Secondary antifungal prophylaxis with voriconazole to adhere to scheduled treatment in leukemic patients and stem cell transplant recipients. Bone Marrow Transplant 2004; 33: 943–949.
Hoffer AF, Gow K, Flynn PM, Davidoff A . Accuracy of percutaneous lung biopsy for invasive pulmonary aspergillosis. Pediatr Radiol 2001; 31: 144–152.
Cordonnier C, Escudier E, Verra F, Brochard L, Bernaudin JF, Fleury-Feith J . Bronchoalveolar lavage during neutropenic episodes: diagnostic yeld and cellular pattern. Eur Respir J 1994; 7: 114–120.
Nosari A, Anghilieri M, Carrafiello G, Guffanti C, Marbello L, Montillo M et al. Utility of percutaneous lung biopsy for diagnosing filamentous fungal infections in hematologic malignancies. Haematologica 2003; 88: 1405–1409.
Gonzales CE, Rinaldi MG, Sugar AM . Zygomycosis. Infect Dis Clin North Am 2002; 16: 895–914.
Brown J . Zygomycosis: an emerging fungal infection. Am J Health Syst Pharm 2005; 62: 2593–2596.
Albeda SM, Talbot GM, Gerson SL, Miller WT, Cassileth PA . Pulmonary cavitation and massive hemoptysis in invasive pulmonary aspergillosis. Influence of bone marrow recovery in patients with acute leukemia. Am Rev Respir Dis 1985; 131: 115–120.
Pagano L, Offidani M, Fianchi L, Nosari A, Candoni A, Piccardi M et al. Mucormycosis in hematologic patients. Haematologica 2004; 89: 207–214.
Kontoyiannis DP, Lionakis MS, Lewis RE, Chamilos G, Healy M, Perego C et al. Zygomycosis in a tertiary-care cancer center in the era of Aspergillus-active antifungal therapy: a case–control observational study of 27 recent cases. J Infect Dis 2005; 15: 1350–1360.
Gleissner B, Schilling A, Anagnostopolous I, Siehl I, Thiel E . Improved outcome of zygomycosis in patients with hematological diseases? Leuk Lymphoma 2004; 45: 1351–1360.
Nosari A, Oreste PL, Montillo M, Carrafiello G, Draisci M, Muti G et al. Mucormycosis in haematologic malignancies: an emerging fungal infection. Haematologica 2000; 85: 1068–1071.
Reichemberger F, Habicht J, Kaim A, Delquen P, Bernet F, Schlapfer R et al. Lung resection for invasive pulmonary aspergillosis in neutropenic patients with hematologic diseases. Am J Crit Care Med 1998; 158: 885–889.
Matt P, Bernet F, Habicht J, Gambizzi F, Gratwolh A, Zerkowsli HR et al. Predicting outcome after lung resection for invasive pulmonary aspergillosis in patients with neutropenia. Chest 2004; 126: 1783–1788.
Yeghen T, Kibbler CC, Prentice HG, Berger LA, Wallesby RK, McWhinney PH et al. Management of invasive pulmonary aspergillosis in hematologic patients: a review of 87 consecutive cases at a single institution. Clin Infect Dis 2000; 31: 859–868.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nosari, A., Ravini, M., Cairoli, R. et al. Surgical resection of persistent pulmonary fungus nodules and secondary prophylaxis are effective in preventing fungal relapse in patients receiving chemotherapy or bone marrow transplantation for leukemia. Bone Marrow Transplant 39, 631–635 (2007). https://doi.org/10.1038/sj.bmt.1705655
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.bmt.1705655
Keywords
This article is cited by
-
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)
Annals of Hematology (2014)
-
Secondary Antifungal Prophylaxis in Hematopoietic Stem Cell Transplantation (HSCT)/Acute Leukemia Patients
Current Infectious Disease Reports (2011)
-
Secondary antifungal prophylaxis in hematological malignancies in a tertiary medical center
International Journal of Hematology (2010)
-
Invasive pulmonary fungal infection accompanied by severe hemoptysis in patients with hematologic diseases: a report of nine cases
International Journal of Hematology (2009)
-
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)
Annals of Hematology (2009)