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Fatal cerebral zygomycosis breakthrough in a patient with acute lymphoblastic leukemia on voriconazole prophylaxis after cord blood SCT

Bone Marrow Transplantation volume 44, pages 765–766 (2009)Cite this article

We have read with great interest the recent article by Trifilio et al.1 on the breakthrough in zygomycosis after the administration of voriconazole in allogeneic stem cell transplant recipients.

Umbilical cord blood is an accepted alternative to BM or mobilized peripheral stem cells as a source of hematopoietic stem cells for allografting patients with hematological malignancies. However, UCBTx is characterized by delayed immune reconstitution, which results from the presence of naive T cells and more potent suppressive T-regulatory cells. Therefore, recipients of UCBTx are more vulnerable to infectious complications, including viral and fungal infections.3, 4 This case report is in line with the paper by Trifilio et al.1 and highlights the risk of unusual fungal infections such as zygomycosis in patients with prolonged administration of voriconazole, especially in case of poor immune recovery such as after UCBTx. It emphasizes the need in such patients to balance the benefits in terms of prevention against the increased risk of breakthrough fatal fungal infections.

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References

  1. Trifilio SM, Bennett CL, Yarnold PR, McKoy JM, Parada J, Mehta J et al. Breakthrough zygomycosis after voriconazole administration among patients with hematologic malignancies who receive hematopoietic stem-cell transplants or intensive chemotherapy. Bone Marrow Transplant 2007; 9: 425–429.

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  2. Rogers TR . Treatment of zygomycosis: current and new options. J Antimicrob Chemother 2008; 61 (Suppl 1): i35–i40.

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  3. Hamza NS, Lisgaris M, Yadavalli G, Nadeau L, Fox R, Fu P et al. Kinetics of myeloid and lymphocyte recovery and infectious complications after unrelated umbilical cord blood versus HLA-matched unrelated donor allogeneic transplantation in adults. Br J Haematol 2004; 124: 488–498.

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  4. Szabolcs P, Niedzwiecki D . Immune reconstitution after unrelated cord blood transplantation. Cytotherapy 2007; 9: 111–122.

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Author notes

  1. I Vande Broek: IVB is a senior clinical investigator of the Research Foundation Flanders

Authors and Affiliations

  1. Division of Clinical Hematology and BMT Unit, University Hospital Brussels, Brussels, Belgium

    I Vande Broek & R Schots

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  1. I Vande Broek
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  2. R Schots
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Correspondence to I Vande Broek.

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Broek, I., Schots, R. Fatal cerebral zygomycosis breakthrough in a patient with acute lymphoblastic leukemia on voriconazole prophylaxis after cord blood SCT. Bone Marrow Transplant 44, 765–766 (2009). https://doi.org/10.1038/bmt.2009.74

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