Marcio Nucci1, Shmuel Shoham2, Edson Abdala3, Nelson Hamerschlak4, Juan Carlos Rico5, Fabio Forghieri6, Simone A Nouér1, Paola Cappellano7, Cristiana Solza8, Yung Gonzaga9, Giampaolo Nadali10, Fabio Nucci11, Arnaldo L Colombo7, Ana Munhoz Albuquerque12, Flavio Queiroz-Telles Filho13, Carlos B L Lima14, Celso Arrais-Rodrigues15, Vanderson Rocha15, Francisco M Marty16. 1. Department of Internal Medicine, University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. 2. Johns Hopkins University School of Medicine, Baltimore, Maryland. 3. Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. 4. Hospital Israelita Albert Einstein, São Paulo, Brazil. 5. Division of Infectious Diseases, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas. 6. Department of Medical and Surgical Sciences, Section of Hematology, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy. 7. Division of Infectious Diseases, Department of Medicine, Federal University of São Paulo, Sao Paulo, Brazil. 8. Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil. 9. Instituto Nacional de Cancer José de Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil. 10. Hematology Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy. 11. Department Hematology, Fluminense Federal University, Niterói, Brazil. 12. Hospital Federal da Lagoa, Rio de Janeiro, Brazil. 13. Department of Public Health, Federal University of Parana, Curitiba, Brazil. 14. Hemorio, Rio de Janeiro, Brazil. 15. Hospital Sírio-Libanês, São Paulo, Brazil. 16. Division of Infectious Diseases, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.
Abstract
BACKGROUND: Patients treated for invasive aspergillosis may relapse during subsequent periods of immunosuppression and should receive secondary prophylaxis. Little is known about the frequency of relapse and practices of secondary prophylaxis for invasive fusariosis (IF). OBJECTIVES: Evaluate practices of secondary prophylaxis and the frequency of relapse in patients who survived IF and were exposed to subsequent periods of immunosuppression. METHODS: Multicentre retrospective study of patients with haematological malignancies who developed IF, survived the initial fungal disease period, and were exposed to subsequent periods of immunosuppression. RESULTS: Among 40 patients, 35 received additional chemotherapy and developed neutropenia (median, 24 days; range, 4-104), and five received glucocorticoids for the treatment of graft-vs-host disease. Overall, 32 patients received secondary prophylaxis (voriconazole in 24) for a median of 112 days (range, 12-468). IF relapsed in five patients (12.5%): 2/8 (25%) not on prophylaxis and 3/32 (9.4%) receiving prophylaxis. Among 28 patients with disseminated IF, relapse occurred in 2/2 (100%) not on prophylaxis and in 3/26 (11.5%) on prophylaxis (P = 0.03). All patients who relapsed IF died. CONCLUSIONS: Patients with IF who survive the initial disease may relapse if exposed to subsequent episodes of immunosuppressive therapies. Secondary prophylaxis should be considered, especially if IF was disseminated.
BACKGROUND:Patients treated for invasive aspergillosis may relapse during subsequent periods of immunosuppression and should receive secondary prophylaxis. Little is known about the frequency of relapse and practices of secondary prophylaxis for invasive fusariosis (IF). OBJECTIVES: Evaluate practices of secondary prophylaxis and the frequency of relapse in patients who survived IF and were exposed to subsequent periods of immunosuppression. METHODS: Multicentre retrospective study of patients with haematological malignancies who developed IF, survived the initial fungal disease period, and were exposed to subsequent periods of immunosuppression. RESULTS: Among 40 patients, 35 received additional chemotherapy and developed neutropenia (median, 24 days; range, 4-104), and five received glucocorticoids for the treatment of graft-vs-host disease. Overall, 32 patients received secondary prophylaxis (voriconazole in 24) for a median of 112 days (range, 12-468). IF relapsed in five patients (12.5%): 2/8 (25%) not on prophylaxis and 3/32 (9.4%) receiving prophylaxis. Among 28 patients with disseminated IF, relapse occurred in 2/2 (100%) not on prophylaxis and in 3/26 (11.5%) on prophylaxis (P = 0.03). All patients who relapsed IF died. CONCLUSIONS:Patients with IF who survive the initial disease may relapse if exposed to subsequent episodes of immunosuppressive therapies. Secondary prophylaxis should be considered, especially if IF was disseminated.