617. Invasive Mold Infections in Patients with Solid Tumors
Session: Abstracts: Mycology
Friday, October 22, 2010
Background: Invasive mold infections (IMI) are usually described in patients with hematological malignancy or organ transplantation. In recent years, there has been increased awareness that a broader spectrum of patients may be at risk for invasive pulmonary aspergillosis, especially patient with COPD or critically ill. In this study we tried to identify the demographic features and the risk factors of IMI in patients with solid tumors (STs) at our institution, a comprehensive cancer center.

Methods: All ST patients with IMI between 2004 and 2008 were included. We modeled our definitions of pulmonary IMI based on the definitions suggested for patients with COPD (proven, probable and possible). Data including demographic characteristics, comorbidities and clinical and radiological were collected. The outcome was assessed clinically and radiologically after the completion of treatment.  

Results: A total of 54 patients were enrolled in our study. Nine patients (16.6%) had proven IMI. Lung cancer was the most common diagnosis (43%) followed by breast cancer (18.6%). Only 11% of cases had COPD. Lymphopenia at the date of infection was reported in 61% of patients, of those 76% had lymphocytes <500 cells/μL for a period more than a month. Only 5.6% of patients had neutropenia (<500 cells/μL). Of 54 patients, 27 had concurrent infection with other microbes. Half of the patients were treated with steroids; one third of them were actively receiving chemotherapy during the month prior to diagnosis. Aspergillus fumigatus was the most common isolated species (62%) mostly from lungs (67%). Two thirds of the patients responded clinically and radiologically to antifungal therapy; most received voriconazole. A third of patients died within 3 months after diagnosis, IMI contributing in 38.9% of them. 

Conclusion: IMI in patients ST is an increasingly recognized entity. Most patients had lung cancer or lung metastasis. As noted in previous reports lymphopenia and use of corticosteroids appear to pose increased risk. In contrast to hematological patients, neutropenia is not a risk factor for IMI. As therapies for solid tumors become increasingly sophisticated, prospective studies are needed to assess the burden of IMI in this patient population.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
Iba Al Wohoush, MD , Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
Coralia Mihu, M.D. , Dept. of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
Dimitrios Kontoyiannis, MD, FIDSA , MD Anderson Cancer Ctr, Houston, TX
Ying Jiang, MS , Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
Ray Hachem, MD , Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX
Kenneth V. I. Rolston, M.D. , Dept. of Infectious Diseases, Infection Control and Employee Health, University of Texas M. D. Anderson Cancer Center, Houston, TX
Issam Raad, MD , Infectious Diseases, Infection Control & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX

Disclosures:

I. Al Wohoush, None

C. Mihu, None

D. Kontoyiannis, Yes
Enzon: Grant Investigator, Speaker's Bureau and research grants,
Astellas: Grant Investigator, Speaker's Bureau and research grant,
Merck: Consultant, Consultant and Speaker's Bureau,
Pfizer: Speaker's Bureau,
Schering-Plough: Consultant and Consultant,

Y. Jiang, None

R. Hachem, Yes
Enzon: Grant Investigator,
Astellas: Grant Investigator,

K. V. I. Rolston, None

I. Raad, Yes
Pfizer: Speaker honoraria and Speaker's Bureau,
Schering-Plough: Speaker honoraria and Speaker's Bureau,
Enzon: Grant Investigator and Research Grants,
Astellas: Grant Investigator and Research Grants,

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