899. Prophylaxis (Px) and Response to Treatment (Tx) of Invasive Mold Infections (IMI) in Hematopoeitic Cell Transplantation (HCT)
Session: Poster Abstract Session: Antifungal Therapy
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • IDSA 2011 09 27 2011.pdf (169.2 kB)
  • Background: Breakthrough IMI despite antifungal Px and poor responses to Tx continue to be a problem in HCT.

    Methods:  Chart review of HCT patients were identified by pathology and microbiology database as having a probable or proven IMI as defined by the European Organization for Research and Treatment of Cancer/Mycoses Study Group from 1998 to 2008. Evaluation included: Px, Tx, and response to Tx at 90-days post onset.

    Results: 214 cases were evaluable: 83% probable and 17% proven. 73% of cases were due to Aspergillus (IA), and 8% Zygomycetes (ZY). 90% were allogeneic HCT. 30% (65/214) of IMI cases were not on Px prior to onset.  However, IMI cases due to multiple organisms, 82% (9/11) were not on Px prior to onset. For ZY, 88% (15/17) were not on ZY active Px.

    Breakthrough IMI

    IA

    N=156 (%)

    ZY

    N=17 (%)

    No Px

    47 (30)

    1 (6)

    Echinocandin (EC)

    36 (23)

    5 (29)

    Fluconazole/Itraconazole

    36 (23)

    6 (36)

    Amphotericin B product (AB) 

    28 (18)

    1 (6)

    Voriconazole (V) 

    5 (3)

    4 (24)

    Posaconazole (P) 

    4 (3)

    0

    Overall 90-day response to Tx for all IMI was 29% (61/214).  Overall response for IA was 30% (46/156). Tx for ZY: overall response was 18% (3/17), and 25% (3/12) if AB was in the regimen. Response rates for other IMI were 20% or less, and most were treated with an azole.  

    Response to Tx

     

     

    P-value

    IA

    V (alone or with EC)

    AB (alone or with EC)

     

     

    26/36 (72%)

    4/16 (25%)

    0.002

    ZY

    AB alone

    No AB in regimen

     

     

    3/9 (33%)

    0/5 (all 5/5 died)

    NS

     

    Conclusion: IMI occurred in cases where no Px was used or where Px may not have provided adequate coverage, specifically, there were no breakthrough ZY on P Px. Response rates were highest if V regimen was used for IA and AB regimen for ZY.


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

    Jane Kriengkauykiat, PharmD1, Bernard Tegtmeier, PhD1, Sanjeet Dadwal, MD1 and James Ito, MD2, (1)City of Hope, Duarte, CA, (2)City of Hope National Medical Center, Duarte, CA

    Disclosures:

    J. Kriengkauykiat, None

    B. Tegtmeier, None

    S. Dadwal, None

    J. Ito, Astellas: Speaker's Bureau, Speaker honorarium
    Merck: Speaker's Bureau, Speaker honorarium
    Pfizer: Speaker's Bureau, Speaker honorarium
    Sigma Tau: Consultant, Consulting fee

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