Abstract 5995
Background
The number of publications on the invasive fungal diseases caused by rare pathogens (rare IFD) after HSCT and chemotherapy is limited.
Methods
From 2008 to 2017 in R. Gorbacheva Memorial Institute of Children Oncology, Hematology and Transplantation (CIC725) have been performed 2738 HSCT including 1845 allogeneic (allo-HSCT) and 893 autologous HSCT (auto-HSCT). During the observation period 40 probable and proven rare IFD (EORTC/MSG 2008 criteria) cases were diagnosed in children and adults with hematological malignances and non-malignant hematological diseases after allo-HSCT (n = 30), auto-HSCT (n = 2), and chemotherapy (n = 8). The median follow up time for rare IFD cases was 3 months; for survivors – 30 months.
Results
Incidence of rare IFD in HSCT recipients was 1,5%, it was higher after allo-HSCT (1,6%) than auto-HSCT (0,2%) (p < 0,01). In 8 patients, this complication developed after CT and 4 of them proceed to allo-HSCT. The most frequent underlying diseases were ALL (33%) and acute AML (30%). The median time of onset of rare IFD after allo-HSCT - 104 (21-1057) days, auto-HSCT – 138 (60-216), after start of CT – 161 (79-189). Etiology of rare IFD was identified by culture in 65% cases: Rhizopus spp. – 27%, Paecilomyces spp. – 7%, Fuzarium spp. – 5%, Malassezia furfur – 5%, Trichosporon asahii – 3%, Scedosporium apiosperium – 2%, Scopulariopsis gracilis – 2%, Rhizomucor pusillus – 2%, Lichtheimia corymbifera – 2%, mix rare IFD with Rhizopus spp. + Paecilomyces spp. – 5%, Paecilomyces spp. + Fuzarium spp. – 5%. 35% cases were diagnosed by microscopy. Antifungal therapy was used in all patients: lipid amphotericin B (L-AmB) – 30%, L-AmB + caspofungin – 22,5%, voriconazole – 17,5%, posaconazole (posa) – 12,5%, L-AmB + posa – 10%, and echinocandins – 7,5%. Overall survival at 12 weeks from the diagnosis of rare IFD was 50%. The 12-weeks overall survival was better in patients after CT and auto-HSCT (80%) than allo-HSCT (42%), p = 0,048.
Conclusions
The incidence of rare IFD in HSCT recipients was 1,5%. Rare IFD is a late complication after chemotherapy and HSCT and usually develops after or in combination with invasive aspergillosis. Higher incidence and worst prognosis rare IFD is observed in allo-HSCT recipients.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Resources from the same session
5054 - Inhibition of Rspo-Wnt pathway Facilitates Checkpoint Blockade Therapy by anti-RSPO3 antibody (DBPR117)
Presenter: John Hsu
Session: Poster Display session 1
Resources:
Abstract
3305 - A phase I dose-escalation and expansion trial of intratumorally administered CV8102, alone and in combination with anti-PD-1 in patients with advanced solid tumors
Presenter: Jürgen Krauss
Session: Poster Display session 1
Resources:
Abstract
5353 - Phase 1/2 Study of 9-ING-41, a small molecule selective Glycogen Synthase Kinase-3 Beta (GSK-3β) Inhibitor, as a Single Agent and Combined with Chemotherapy, in Patients with Refractory Hematological Malignancies or Solid Tumors
Presenter: Benedito Carneiro
Session: Poster Display session 1
Resources:
Abstract
3946 - Trial in progress: a Phase I, open-label study of GSK1795091 administered in combination with immunotherapies in participants with advanced solid tumors (NCT03447314).
Presenter: Aaron Hansen
Session: Poster Display session 1
Resources:
Abstract
3449 - Radiographic Phenotyping to Identify Intracranial Disseminated Recurrence in Brain metastases Treated With Radiosurgery Using Contrast-enhanced MR Imaging
Presenter: CheYu Hsu
Session: Poster Display session 1
Resources:
Abstract
4553 - Association between TP53 mutations and efficacy of Osimertinib for brain metastasis from EGFR-mutant lung cancer
Presenter: Lijuan Chen
Session: Poster Display session 1
Resources:
Abstract
4942 - Response assessment of melanoma brain metastases treated by stereotactic radiotherapy or immunotherapy or both: a comparison of RECIST 1.1, RANO and iRANO criteria
Presenter: Emilie Le Rhun
Session: Poster Display session 1
Resources:
Abstract
3529 - Management of multiple brain metastases by Staged SRS focusing on utmost risk lesions
Presenter: shaoqun Li
Session: Poster Display session 1
Resources:
Abstract
5315 - Whole brain radiotherapy plus simultaneous in-field boost versus whole brain radiotherapy plus fractionated stereotactic radiotherapy for multiple brain metastases of non-small cell lung cancer
Presenter: Lu Li
Session: Poster Display session 1
Resources:
Abstract
1116 - 3D based texture analysis serving as potential diagnostic factor in discriminating primary central nervous system lymphoma from metastatic brain tumors: A preliminary study
Presenter: Wen Guo
Session: Poster Display session 1
Resources:
Abstract