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著者: Matthew A Miller, Kyle C Molina, Jonathan A Gutman, Sias Scherger, Jessica M Lum, Sherif B Mossad, Mary Burgess, Matthew P Cheng, Sally T Chuang, Samantha E Jacobs, Dante P Melendez, Dimpy P Shah, Andrea Zimmer, M Rizwan Sohail, Sadia Syed, Randall C Walker, Eric M Poeschla, Maheen Z Abidi
雑誌名: Open Forum Infect Dis. 2021 Feb;8(2):ofaa646. doi: 10.1093/ofid/ofaa646. Epub 2020 Dec 30.
Abstract/Text
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.
© The Author(s) 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
PMID 33575424 Open Forum Infect Dis. 2021 Feb;8(2):ofaa646. doi: 10.1093/ofid/ofaa646. Epub 2020 Dec 30.
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