1097. Clinical Description of Invasive Fungal Infection (IFI) secondary to Acremonium spp in Patients with Hematologic Malignancy (HM)/ Hematopoietic Cell Transplantation (HCT)
Session: Poster Abstract Session: Infections in Hematopoietic Stem Cell Transplant and Cancer Chemotherapy Recipients
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • IDSA 2011 Acremonium 10 22 2011.pdf (112.6 kB)
  • Background: Acremonium spp are an emerging cause of IFI in the HM/ HCT.  Optimal treatment is not well defined and reported outcomes are poor, with mortality similar to that of Fusarium spp.

    Methods: Chart review of HM/ HCT patients (>18 years of age) with proven or probable IFI caused by Acremonium spp., from 1990 to 2011, as defined by the European Organization for Research and Treatment of Cancer/ Mycosis Study group.

    Results: 9 cases of IFI were identified (5 proven and 4 probable). Median age 47 years. 5 had acute leukemia, 1 chronic leukemia, 3 lymphoma and 1 multiple myeloma. 5/ 9 had matched allogenic HCT (3 unrelated, 2 related donor) and 4 HM. 1 HCT had active chronic graft versus host disease (cGVHD). 4 HCT’s were on immunosuppressants. 7 were on steroids. 4 had fungemia (1 each with skin and brain lesions), 4 had sinus involvement, 3 had pneumonia, and 2 had skin lesions. 3 were in remission, 2 relapsed after HCT and 4 had refractory disease.  7 were receiving antifungal prophylaxis at diagnosis (amphotericin B product - 2, echinocandin - 3, and fluconazole - 2). Median duration of antifungal prophylaxis was 41 days.  Serology: 6 had aspergillus galactomannan antigen tests with 1 serum positive (proven case), and 2 positive in bronchoalveolar lavage fluid with no microbiologic evidence of aspergillus co-infection (1 proven and 1 probable). 5 had beta D-glucan test: 3 positives (2 had proven infection). Treatment: 1 died before initiation of treatment, 3 had monotherapy (voriconazole 2, echinocandin 1) and 5 had amphotericin B product in combination with echinocandin (1) or azole (4). 3 had sinus debridement and 2 had tunneled catheter removed. 2 fungal isolates from proven cases had antifungal susceptibility; MIC for echinocandins >8, and in one MIC for posaconazole > 16. Median duration of treatment was 44 days. 5 (56%) died within 90 days of onset of IFI. 4 deaths occurred in 6 patients with relapsed/ refractory disease (67%).

    Conclusion: Acremonium spp. IFI in the HM/ HCT population has high mortality despite aggressive antifungal therapy, especially in persistent hematologic disorder/ neutropenic state.


    Subject Category: O. Transplant infectious diseases

    Sanjeet Dadwal, MD1, Jane Kriengkauykiat, PharmD1, Bernard Tegtmeier, PhD2 and James Ito, MD1, (1)City of Hope National Medical Center, Duarte, CA, (2)City of Hope, Duarte, CA

    Disclosures:

    S. Dadwal, None

    J. Kriengkauykiat, None

    B. Tegtmeier, 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

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.