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. 2022 Nov;65(11):1061-1067.
doi: 10.1111/myc.13496. Epub 2022 Jul 25.

When and how do we stop antifungal treatment for an invasive mould infection in allogeneic haematopoietic cell transplant recipients?

Romain Samuel Roth  1 , Stavroula Masouridi-Levrat  2 , Federica Giannotti  2 , Anne-Claire Mamez  2 , Sarah Morin  2 , Christian van Delden  1 , Yves Chalandon  2 , Dionysios Neofytos  1
Affiliations

When and how do we stop antifungal treatment for an invasive mould infection in allogeneic haematopoietic cell transplant recipients?

Romain Samuel Roth et al. Mycoses. 2022 Nov.

Abstract

Background: Limited data exist to describe end-of-treatment (EOT) parameters of antifungal therapy for invasive mould infections (IMI).

Methods: In a 10-year cohort of consecutive adult allogeneic haematopoietic cell transplant recipients with proven/probable IMI, we describe treatment duration and patient profile at EOT.

Results: There were 61 patients with 66 proven/probable IMI identified: 47/66 (71%) invasive aspergillosis (IA), 11/66 (17%) mucormycosis, and 8/66 (12%) other-IMI. Excluding 5 (8%) patients lost to follow-up, treatment was prematurely discontinued due to death or palliative care in 29/56 (51.8%) patients. Antifungal treatment was completed in 27 (48.2%) patients, for a median duration of 280 days (IQR: 110, 809): 258 (IQR: 110, 1905) and 307.5 (99, 809) days in IA and non-IA IMI, respectively. Treatment was continued after 90 and 180 days in 43/56 (76.8%) and 30/56 (53.6%) patients, respectively. At EOT, most patients were not neutropenic (ANC: 2.12 G/L, IQR: 0.04, 5.3), with CD4+ counts at 99 cells/μl (IQR: 0, 759) and immunoglobulins at 5.6 g/L (IQR: 2.3, 10.6). Most patients (16/27, 59.3%) were not receiving steroids at EOT, while 14/27 (53.9%) were on another type of immunosuppression. Amongst 15 patients with imaging at EOT, 12 (80%) had complete/partial radiologic response. Any chart documentation or an infectious disease consultation on treatment discontinuation was observed in 12/56 (21%) and 11/56 (20%) patients, respectively.

Conclusions: Long treatment courses are observed in patients with IMI, due to prolonged immunosuppression. Although immune reconstitution and radiological response were frequently observed at EOT, consistent documentation of treatment discontinuation based on well-defined parameters is lacking.

Keywords: allogeneic haematopoietic cell transplant recipients; antifungal treatment discontinuation; antifungal treatment stop; invasive mould infections.

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Conflict of interest statement

R.S.R., S.M‐L., F.G., A‐C.M. and C.v.D.: No conflicts of interest. Y.C. has received consulting fees from MSD, Novartis, Incyte, BMS, Pfizer, Abbvie, Roche, Jazz, Gilead, Amgen, Astra‐Zeneka Servier and travel support from MSD, Roche, Gilead, Amgen, Incite, Abbvie, Janssen, Astra‐Zeneka, Jazz. D.N. has received research support from MSD and Pfizer and consulting fees from Roche Diagnostics, MSD, Pfizer, Basilea and Gilead.

Figures

FIGURE 1
FIGURE 1
Time to treatment discontinuation for patients whose treatment was considered completed and for those patients whose treatment was discontinued due to death or palliative care during the first year after treatment initiation
FIGURE 2
FIGURE 2
Reasons to prolong antifungal treatment for the treatment of invasive mould infections beyond 3‐ and 6‐month post‐treatment initiation
FIGURE 3
FIGURE 3
Documentation of end‐of‐treatment decision by the primary Haematology service and by the Infectious Disease service in patient charts
See this image and copyright information in PMC

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