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The impact of prior invasive mold infections in leukemia patients who undergo allo-SCT in the era of triazole-based secondary prophylaxis

Bone Marrow Transplantation volume 48, pages 141–143 (2013)Cite this article

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Invasive mold infections (IMIs) can complicate intensive myelosuppressive chemotherapy for hematological malignancies, particularly acute leukemia. As allogeneic hematopoietic SCT (HSCT) is often the only curative treatment for the majority of these patients, clinicians often encounter the therapeutic dilemma of balancing further cytotoxic therapy and HSCT with the risk of IMI relapse-related morbidity and death. Although improvements in diagnosis and the introduction of new antifungal agents have improved prognosis for IMIs, the possibility of post-transplant IMI relapse is considerable and historically associated with poor outcomes.1, 2, 3

The aim of the present study was to evaluate the IMI relapse rate and associated mortality rate after allogeneic HSCT in a contemporary cohort of patients with hematological malignancies at a tertiary care cancer center. To that end, we retrospectively evaluated all patients at The University of Texas MD Anderson Cancer Center in whom a proven or probable IMI (according to the revised definitions of the European Organization for Research and Treatment of Cancer (EORTC) and Mycoses Study Group (MSG)) developed before HSCT from 1 January 2005 to 31 December 2008. Patients’ electronic records were reviewed for their demographic characteristics, underlying hematological malignancies, antifungal treatments, conditioning regimens before HSCT, secondary antifungal prophylaxis, time of IMI relapse, and outcome at 6 and 12 months after HSCT. Treatment response was defined as partial (PR) or complete (CR) or a failure based on the EORTC/MSG consensus criteria. Mortality was attributed to IMI if the patient had clinical, microbiological and/or radiological evidence of active fungal infection at the time of death. An IMI was considered a breakthrough infection if it was caused by an organism different from the one that caused the infection that led to initiation of secondary antifungal prophylaxis, or if it was developed at least within 7 days after initiation of secondary antifungal prophylaxis. The study protocol was approved by the MD Anderson Institutional Review Board.

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Acknowledgements

We thank Dr Gabriella Rondon for assistance with the identification of study subjects. This research is supported in part by the National Institutes of Health through MD Anderson's Cancer Center Support Grant CA016672. DPK acknowledges the Frances King Black Endowed Professorship for Cancer Research.

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Authors and Affiliations

  1. Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    S P Georgiadou, R E Lewis, L Best, H A Torres & D P Kontoyiannis

  2. Department of Stem Cell Transplantation & Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    R E Champlin

Authors
  1. S P Georgiadou
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  2. R E Lewis
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  3. L Best
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  4. H A Torres
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  6. D P Kontoyiannis
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Correspondence to D P Kontoyiannis.

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Competing interests

DPK has received research support and honoraria from Pfizer; Astellas Pharma US; Gilead Sciences, Inc.; and Merck and Co., Inc. HAT is a consultant for Merck and Co., Inc.; Astellas Pharma US; and Vertex Pharmaceuticals, and has received research grants from Merck and Co., Inc. REL has received research support from Merck and Co. Inc., and Astellas Pharma US. All other authors reported no conflicts.

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Georgiadou, S., Lewis, R., Best, L. et al. The impact of prior invasive mold infections in leukemia patients who undergo allo-SCT in the era of triazole-based secondary prophylaxis. Bone Marrow Transplant 48, 141–143 (2013). https://doi.org/10.1038/bmt.2012.89

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