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. 2020 Dec 30;8(2):ofaa646.
doi: 10.1093/ofid/ofaa646. eCollection 2021 Feb.

Mucormycosis in Hematopoietic Cell Transplant Recipients and in Patients With Hematological Malignancies in the Era of New Antifungal Agents

Matthew A Miller  1 , Kyle C Molina  1 , Jonathan A Gutman  2 , Sias Scherger  3 , Jessica M Lum  4 , Sherif B Mossad  4 , Mary Burgess  5 , Matthew P Cheng  6   7 , Sally T Chuang  8 , Samantha E Jacobs  9 , Dante P Melendez  10 , Dimpy P Shah  11 , Andrea Zimmer  12 , M Rizwan Sohail  13 , Sadia Syed  14 , Randall C Walker  14 , Eric M Poeschla  3 , Maheen Z Abidi  3
Affiliations

Mucormycosis in Hematopoietic Cell Transplant Recipients and in Patients With Hematological Malignancies in the Era of New Antifungal Agents

Matthew A Miller et al. Open Forum Infect Dis. .

Abstract

Background: The survival benefit of combination antifungal therapy for invasive mucormycosis (IM) in patients with hematologic malignancy (HM) and hematopoietic cell transplant (HCT) is not well defined.

Methods: This multicenter, retrospective study included HM and HCT recipients with proven or probable IM between January 1, 2007 and December 31, 2017 from 10 transplant centers across North America.

Results: Sixty-four patients with proven (n = 47) or probable (n = 17) IM defined by 2008 European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) consensus definitions were included. Thirty-nine (61%) were HCT recipients (95% allogeneic). Sites of infection included rhino-orbital-cerebral (33), pulmonary (30%), disseminated (19%), gastrointestinal (3%), and cutaneous (3%). Surgical debridement was performed in 66%. Initial antifungal treatment consisted of the following: lipid formulation of amphotericin B (AmB) alone (44%), AmB + posaconazole (25%), AmB + echinocandin (13%), AmB + isavuconazole (8%), posaconazole alone (5%), and isavuconazole alone (3%). All-cause mortality at 30 days and 1 year were 38% and 66%, respectively. Initial treatment with AmB plus posaconazole or isavuconazole (n = 28) was associated with a trend toward lower treatment failure compared with AmB (n = 21) (42% vs 64%, P = .136).

Conclusions: Long-term survival with IM among HM and HCT populations remains poor. However, initial use of AmB + azole in conjunction with surgery may result in less treatment failure. More evidence from prospective controlled studies is needed to confirm this observation.

Keywords: Hematopoeitic cell Transplant; Isavuconazole; Mucormycosis.

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Figures

Figure 1.
Figure 1.
Desirability of outcome ranking (DOOR) analysis comparing lipid formulation of amphotericin B (AmB) monotherapy and combination therapy with AmB + posaconazole/isavuconazole (POS/ISA).
See this image and copyright information in PMC

References

    1. Cornely OA, Alastruey-Izquierdo A, Arenz D, et al. ; Mucormycosis ECMM MSG Global Guideline Writing Group. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis 2019; 19:e405–21. - PMC - PubMed
    1. Park BJ, Pappas PG, Wannemuehler KA, et al. Invasive non-Aspergillus mold infections in transplant recipients, United States, 2001-2006. Emerg Infect Dis 2011; 17:1855–64. - PMC - PubMed
    1. Kontoyiannis DP, Lewis RE. How I treat mucormycosis. Blood 2011; 118:1216–24. - PMC - PubMed
    1. De Pauw B, Walsh TJ, Donnelly JP, et al. ; European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group; National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 2008; 46:1813–21. - PMC - PubMed
    1. Pongas GN, Lewis RE, Samonis G, Kontoyiannis DP. Voriconazole-associated zygomycosis: a significant consequence of evolving antifungal prophylaxis and immunosuppression practices? Clin Microbiol Infect 2009; 15 Suppl 5:93–7. - PubMed