OBJECTIVES: Invasive fungal disease (IFD) remains a major concern in patients with haematological conditions. We describe diagnoses, therapeutic management and outcomes in unselected consecutive patients from haematological facilities treated for suspected or documented IFD. METHODS: In this observational prospective study, children/adults with haematological conditions or haematopoietic stem cell transplantation (HSCT) were recruited upon start of non-prophylactic systemic antifungal treatment in 37 French haematological facilities (December 2007 to December 2008). IFD episodes were classified according to the 2008 EORTC/MSG criteria. RESULTS: The cohort included 419 patients (298 adults and 121 children): 88% haematological malignancies, 28% HSCT recipients and 68% neutropenic. Patients had 423 IFD episodes: 21% mycologically documented (59% probable/proven aspergillosis, 32% proven candidiasis and 9% probable/proven other IFD) and 20% classified as possible IFD. The remaining cases were assigned to two groups: febrile neutropenia (34%) and unclassified (25%), 9% of which were classified as possible/probable/proven IFD by day 7. Treatment was thus initiated early in 59% of patients; liposomal amphotericin B and caspofungin were the most common single-agent therapies. The 12 week mortality was 18% for probable/proven aspergillosis, 15% for proven candidiasis, 10% for probable/proven other IFD, 9% for possible IFD, 3% for febrile neutropenia and 12% for unclassified episodes (log rank P = 0.016); it was dependent on age, complete remission of underlying haematological disease and mechanical ventilation. CONCLUSIONS: In this comprehensive sample of haematological patients receiving antifungal treatment, we observe a widespread resort to early therapy and a low mortality rate, including in patients with probable or proven IFD.
OBJECTIVES: Invasive fungal disease (IFD) remains a major concern in patients with haematological conditions. We describe diagnoses, therapeutic management and outcomes in unselected consecutive patients from haematological facilities treated for suspected or documented IFD. METHODS: In this observational prospective study, children/adults with haematological conditions or haematopoietic stem cell transplantation (HSCT) were recruited upon start of non-prophylactic systemic antifungal treatment in 37 French haematological facilities (December 2007 to December 2008). IFD episodes were classified according to the 2008 EORTC/MSG criteria. RESULTS: The cohort included 419 patients (298 adults and 121 children): 88% haematological malignancies, 28% HSCT recipients and 68% neutropenic. Patients had 423 IFD episodes: 21% mycologically documented (59% probable/proven aspergillosis, 32% proven candidiasis and 9% probable/proven other IFD) and 20% classified as possible IFD. The remaining cases were assigned to two groups: febrile neutropenia (34%) and unclassified (25%), 9% of which were classified as possible/probable/proven IFD by day 7. Treatment was thus initiated early in 59% of patients; liposomal amphotericin B and caspofungin were the most common single-agent therapies. The 12 week mortality was 18% for probable/proven aspergillosis, 15% for proven candidiasis, 10% for probable/proven other IFD, 9% for possible IFD, 3% for febrile neutropenia and 12% for unclassified episodes (log rank P = 0.016); it was dependent on age, complete remission of underlying haematological disease and mechanical ventilation. CONCLUSIONS: In this comprehensive sample of haematological patients receiving antifungal treatment, we observe a widespread resort to early therapy and a low mortality rate, including in patients with probable or proven IFD.
Authors: Yuqian Sun; He Huang; Jing Chen; Jianyong Li; Jun Ma; Juan Li; Yingmin Liang; Jianmin Wang; Yan Li; Kang Yu; Jianda Hu; Jie Jin; Chun Wang; Depei Wu; Yang Xiao; Xiaojun Huang Journal: Tumour Biol Date: 2014-10-08
Authors: Anthony W Martinelli; Callum B Wright; Marta S Lopes; Rosemary L Swayne; Pramila Krishnamurthy; Charles Crawley; Ben Uttenthal; George Follows; Judith Babar; Sani H Aliyu; David A Enoch; Clare R Sander Journal: J Med Microbiol Date: 2022-07 Impact factor: 3.196
Authors: Junru Liu; He Huang; Yan Li; Lin Liu; Jianyong Li; Zhuogang Liu; Jin Lu; Jian Ouyang; Yongping Song; Daobin Zhou; Hanyun Ren; Jun Ma; Chun Wang; Li Yu; Jin Zhou; Jianmin Wang; Yang Xiao; Xiaojun Huang; Juan Li Journal: Tumour Biol Date: 2015-12-23
Authors: Rayo Morfín-Otero; Martha Alvarado-Ibarra; Eduardo Rodriguez-Noriega; Jesus Resendiz-Sanchez; Dipen A Patel; Jennifer M Stephens; Manuela Di Fusco; Carlos F Mendoza; Claudie Charbonneau Journal: Clinicoecon Outcomes Res Date: 2018-09-06