1211. Temporal Trends in Stem Cell Transplant and Hematologic Malignancy Patients with Mucormycosis, 2001-2014
Session: Poster Abstract Session: Transplant: Epidemiology of Infections in Transplant Patients and Other Patients with Impaired Immunity
Friday, October 9, 2015
Room: Poster Hall
Background: Mucormycosis is associated with substantial mortality, particularly among oncology patients. In view of recent advances in hematopoetic stem cell transplantation (SCT), antifungal drugs and supportive care, we studied temporal trends in clinical features among SCT and hematologic malignancy patients with mucormycosis.

Methods: We retrospectively assessed clinical characteristics at the time of diagnosis, all-cause  and mucormycosis-attributable mortality rates among adult SCT and hematologic malignancy patients, diagnosed at our institution from 2001 to 2014 with proven or probable mucormycosis by EORTC/MSG criteria.

Results: 48 patients were diagnosed with probable or proven mucormycosis during the study. Median age was 56 years (range 19-83) and 34 (71%) were men. The proportion of SCT recipients and the proportion with disseminated disease decreased over the study period, whereas the proportions of patients with acute leukemia and those with neutropenia (<500 neutrophils/μL) increased (Table). Pulmonary and disseminated mucormycosis were the most common manifestations (16, 33% each), followed by sinus (13, 27%), skin (2, 4%) and gastrointestinal (1, 2%) disease. Species were microbiologically identified in 22 patients (46%): Rhizopus (8, 17%), Mucor (7, 15%), Rhizomucor (3, 6%), Cunninghamella (3, 6%), and Lichtheimia (1, 2%). Overall, all-cause six and twelve-week mortality rates were 44% and 50%, respectively.

Conclusion: Among immunosuppressed patients with mucormycosis, we noted an epidemiologic shift from SCT recipients to neutropenic patients with acute leukemia. Despite major advances in antifungal treatment and chemotherapy, mucormycosis is still associated with relatively frequent dissemination and high mortality rates.

 

 

2001-05

2006-10

2011-14

Number of Cases

19

14

15

SCT

15 (79%)

1 (7%)

3 (20%)

Acute leukemia

4 (21%)

10 (71%)

12 (80%)

Neutropenia

4 (21%)

10 (71%)

10 (67%)

Disseminated disease

9 (47%)

4 (29%)

3 (20%)

Mortality

All-cause

 

 

 

            6-week

10 (53%)

5 (36%)

6 (40%)

            12-week

12 (63%)

5 (36%)

7 (47%)

Attributable

 

 

 

            6-week

8 (42%)

4 (29%)

4 (27%)

            12-week

9 (47%)

4 (29%)

5 (33%)

Ann E. Woolley, MD1,2,3, Dimitrios Farmakiotis, MD3,4, Alexis Liakos, PA-C1, Nicolas C. Issa, MD1,3, Sophia Koo, MD1,3,5, Lindsey R. Baden, MD3,4,5, Francisco M. Marty, MD, FIDSA3,5,6 and Sarah P. Hammond, MD1,3, (1)Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, (2)Infectious Disease, Massachusetts General Hospital, Boston, MA, (3)Infectious Diseases, Dana-Farber Cancer Institute, Boston, MA, (4)Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, (5)Harvard Medical School, Boston, MA, (6)Infectious Diseases, Brigham and Women's Hospital - Harvard Medical School, Infectious Diseases, Boston, MA

Disclosures:

A. E. Woolley, None

D. Farmakiotis, None

A. Liakos, None

N. C. Issa, None

S. Koo, None

L. R. Baden, None

F. M. Marty, None

S. P. Hammond, None

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