A retrospective study of fungal infections in patients with haematologic malignancies

Abstract number: 1134_01_195

Michalis E., Chitiroglou K., Arseni P., Tsourveloudis I., Karabatsaki H., Galanopoulos A., Marinakis T., Zomas A., Anagnostopoulos N.

Invasive Fungal Infections (IFI) represent a significant problem for patients with haematologic malignancies undergoing intensive chemotherapy. The incidence and severity of IFI vary and result from the interaction of the following risk factors: previous fungal infection, state of immunosuppression and organ dysfunction.

Objectives:  

In this retrospective study we estimated the incidence of fungal infections and the toxicity of antifungal treatment.

Patients and methods:  

77 patients of median age 66 years admitted in our department between November 2001 and June 2003. The median time of hospitalization was 30 days. They were stratified in nine groups: Acute myelogenous leukaemia:40, acute lymphoblastic leukaemia:8, myelodyspoastic syndrome:7, multiple myeloma:4, myeloproliferative disease:3, non Hodgkin lymphoma:11, chronic myelogenous leukaemia:1, aplastic anemia:1, Hodgkin's disease:1. A fungal infection was determined as definite, if biologic fluids cultures or a lesion tissue biopsy were positive for fungi, as probable if imagine technique findings were indicative for fungal infection and possible if patients became afebrile after empirical antifungal treatment. The period of neutropenia was approximately 15 days. The antifungal medication included liposomal amphotericin in 38/77, amphotericin B lipid complex (ABLC) in 29/77, voriconazole in 1/77 and caspofugin in 2/77.

Results:  

18/77(24%) had a definite, 17/77(22%) a probable and 42/77(54%) a possible fungal infection. Blood cultures were positive for Candida species in 8/77(10%). Positive urine cultures were eliminated in 3/77(4%), sputum cultures in 5/77(6.5%), whereas one patient had positive CSF culture for cryptococcus. Aspergillus spp. was eliminated from the pleural cavity of a patient with empyema during neutropenia period. A 6.5% of patients had both bacterial and fungal infection. Computerized scanning findings were suspicious of fungal infection in 14/77(18.2%). Side effects: ABLC caused fever, renal dysfunction and decreased potassium serum level in 73%, whereas liposomal amphotericin in 63%. The incidence of side effects was not statistically different between the two amphotericin arms (p = 0.36). The mortality was 68% and 42% on ABLC and liposomal amphotericin group respectively (p = 0.039).

Conclusions:  

Toxicity was more severe on ABLC arm and Candida species were the most frequent eliminated fungi. The duration of neutropenia and immunodeficiency seemed to be important risk factors for fungal infections.