Epidemiology and treatment approaches in management of invasive fungal infections in hematological malignancies: Results from a single-centre study

• DOI: 10.1371/journal.pone.0216715
• Publication Date: 2019-05-09T13:37:48Z
• Authors: Nicola Stefano Fr...; Mariarita Sciumè; Nicola Orofino; Francesca Guidotti; Anna Grancini; Fabrizio Cavalca; Alessandra Freyrie; Maria Cecilia Gol...; Dario Consonni; Veronica Mattiello; Loredana Pettine; Agostino Cortelezzi
• Keywords: Posaconazole; Galactomannan; Hematology

Invasive fungal infections (IFIs) are a leading cause of morbidity and attributable mortality in oncohematologic patients. Timely diagnosis is essential but challenging. Herein we retrospectively describe 221 cases antifungal treatments (AFT) administered monocentric real-life cohort hematological malignancies. Between January 2010 July 2017, 196 patients were treated with AFT at our Hematology Department. Diagnosis IFIs was carried out according to EORTC/MSG-2008 guidelines.The most represented disease acute myeloid leukemia (104 patients). Median age 61 years; fever onset 177 (80%) had neutrophil count<0.5x109/L. Twenty-nine (13%) receiving prophylaxis (26 posaconazole, 2 fluconazole, 1 itraconazole). The incidence 13%. Serum galactomannan antigen (GM) positive 20% the tested cases, while 85% CT scan suggestive for IFI. Twenty-one percent these GM positive. Sixty-five (33%) showed culture results, particular Candida spp. identified 45 isolates, Aspergillus 16 cases. Fourteen presented multiple positivity. Twenty-two (10%) classified as proven IFIs, (28%) probable 81 (37%) possible, 57 (26%) could not be classified. Fifty-nine received single agent AFT, 37% sequential 8% combination regimen. Liposomal-amphotericin-B used AFT. 20%. This epidemiologic survey underlined persistent significant use high rate IFIs. We suggest that further powerful diagnostic approaches should investigated improve accuracy potential therapeutic implication.