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Successful allogeneic haematopoietic stem cell transplantation in patients with poor-risk leukaemia and prior invasive fungal infection

Bone Marrow Transplantation volume 34, pages 825–826 (2004)Cite this article

Invasive fungal infections (IFI) are a significant cause of morbidity and mortality after haematopoietic stem cell transplantation (HSCT).1 Patients with a history of IFI are thought to be at a high risk of suffering reactivation during subsequent chemotherapy and HSCT.2, 3 We have allografted three patients with a history of IFI within the preceding 4–6 months.

A 44-year-old woman with Ph+ ALL developed right-sided facial swelling and loss of vision during induction chemotherapy. Ethmoid sinusitis was detected on MRI. Cultures of right ethmoid biopsy grew mucor (Abcedea corymebifera), which was sensitive to amphotericin and itraconazole. She was treated with liposomal amphotericin (LA) 5 mg/kg for 2 months and G-CSF during neutropenia. She responded well with reduction in facial swelling, and complete resolution of fever and inflammatory markers. Vision did not recover. After 5 months, she underwent conventional-intensity HSCT from an HLA-matched sibling, receiving itraconazole 200 mg twice daily and liposomal amphotericin 100 mg every other day prophylactically. LA was stopped on day +20 but itraconazole was continued. LA was restarted on day +35 at a dose of 1 mg/kg every other day when systemic steroids were administered for GVHD, and was discontinued on day +68. She is currently 10 months post transplant, in molecular remission and with no evidence of active fungal infection.

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References

  1. Gold JW . Opportunistic fungal infections in patients with neoplastic disease. Am J Med 1984; 76: 458–463.

    Article  CAS  PubMed  Google Scholar 

  2. Robertson MJ, Larson RA . Recurrent fungal pneumonias in patients with acute nonlymphocytic leukaemia undergoing multiple courses of intensive chemotherapy. Am J Med 1988; 84: 233–239.

    Article  CAS  PubMed  Google Scholar 

  3. Rousey SR, Russler S, Gottlieb M et al. Low dose amphotericin-B prophylaxis against invasive aspergillus infections in allogeneic marrow transplantation. Am J Med 1991; 91: 484–492.

    Article  CAS  PubMed  Google Scholar 

  4. Goodrich JM, Reed EC, Mori M et al. Clinical features and analysis of risk factors for invasive candidial infection after marrow transplantation. J Infect Dis 1991; 164: 731–740.

    Article  CAS  PubMed  Google Scholar 

  5. Denning DW, Martinus A, Cohen J et al. An EORTC multicentre prospective survey of invasive aspergillosis in haematologic patients: diagnosis and therapeutic outcome. J Infect 1998; 37: 173–180.

    Article  CAS  PubMed  Google Scholar 

  6. Richard C, Romon I, Baro J et al. Invasive pulmonary aspergillosis prior to bone marrow transplant in acute leukaemia patients does not predict a poor outcome. Bone Marrow Transplant 1993; 12: 237–241.

    CAS  PubMed  Google Scholar 

  7. Hoover M, Morgan ER, Kletzel M . Prior fungal infection is not a contraindication to bone marrow transplant in patients with acute leukaemia. Med Ped Oncol 1997; 28: 268–273.

    Article  CAS  Google Scholar 

  8. Martino R, Nomdedeu J, Altes A et al. Successful bone marrow transplantation in patients with previous invasive fungal infections: report of four cases. Bone Marrow Transplant 1994; 13: 265–269.

    CAS  PubMed  Google Scholar 

  9. Singhal S, Safdar A, Chiang KY et al. Non-myeloablative allogeneic transplantation (‘microallograft’) for refaractory myeloma after two preceding autografts: feasibility and efficacy in a patient with active aspergillosis. Bone Marrow Transplant 2000; 26: 1231–1233.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Haematology, Bone Marrow Transplantion Unit, University Hospital, Birmingham NHS Trust, Birmingham, UK

    P Mehta, B Augustson, S Krishnamurthy, M Cook, C Craddock & P Mahendra

  2. Department of Haematology, New Cross Hospital, Wolverhampton, UK

    A Jacob & D Roy

  3. Department of Radiology, University Hospital Birmingham, NHS Trust, Birmingham, UK

    J Olliff

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  1. P Mehta
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  2. B Augustson
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Mehta, P., Augustson, B., Krishnamurthy, S. et al. Successful allogeneic haematopoietic stem cell transplantation in patients with poor-risk leukaemia and prior invasive fungal infection. Bone Marrow Transplant 34, 825–826 (2004). https://doi.org/10.1038/sj.bmt.1704685

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