1. ¹Department of Hematology, Niguarda Ca'Granda Hospital, Milan, Italy
2. ²Thoracic Surgery Unit, Niguarda Ca'Granda Hospital, Milan, Italy

Correspondence: Dr A Nosari, Divisione di Ematologia, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20162 Milano, Italy. E-mail: miccaimi@tin.it

Received 26 June 2006; Revised 30 December 2006; Accepted 4 January 2007; Published online 26 March 2007.

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.