125. Invasive mucormycosis in patients with hematological diseases identified in the global FungiScope registry
Session: Oral Abstract Session: Epidemiology and Outcomes in Mycology
Thursday, October 27, 2016: 11:45 AM
Room: 288-290
Background:
Invasive fungal diseases (IFD) are a frequent complication in hematological patients. Hematological malignancies and their treatment are main risk factors for IFD. Less frequent IFD, such as invasive mucormycoses (IM), are increasing worldwide and are associated with mortality up to 100%. Efficient diagnostic and treatment approaches for IM are not known or validated yet. Thus, it is urgent to better understand clinical presentation and management of IM in hematological patients to eventually improve patient outcome.

Methods:
Clinical data on IM were collected in FungiScope™, an international web-based registry. Cases with cultural, histological or molecular evidence of IM are enrolled. Data collected include demographics, underlying conditions and their treatment, clinical signs and symptoms, sites of infection, diagnostic tests, antifungal treatment and outcome. Clinical isolates are collected for centralized identification, molecular analyses and exchange between collaborators.

Results:
To date, 158 cases of IM with an underlying hematologic disease (HD) were captured in the FungiScope database. AML, ALL, Non-Hodgkin’s Lymphoma and CLL were the most frequent malignancies (46.8%, 19%, 7%, and 5.7%, respectively). Treatment of HD was chemotherapy in 75%, for 70% of these it was the primary course. Prolonged neutropenia (>10 days) was reported in 51% of cases. The majority of patients received antifungal agents (79%; median 42 days, range 1-733 days) and 37% underwent surgical debridement. Antifungals known to be active against Mucorales (amphotericin B, isavuconazole, itraconazole, posaconazole) were administered in 86% of cases, in 23% of those amphotericin B was used as a single agent. Median follow‑up time was 46 days (range 0-1394 days). Favourable response (complete or partial response or stable disease) resulted in 42% of cases. Overall mortality was 65% and death due to IM was reported for 78% of cases. For patients who were not treated for IM, mortality exceeded 90%.

Conclusion:
The FungiScope registry is a feasible approach to collect data on a relevant amount of rare cases of IM. IM remains a life threatening disease in hematological patients. Despite aggressive antifungal treatment strategies outcome remains poor. More effective treatment strategies are urgently needed to improve patient outcome.

Danila Seidel, PhD1, Luisa Duran Graeff, MD1, Maria Vehreschild, MD1, Janne Vehreschild, MD1, Blasius Liss, MD1, Philipp Köhler, MD1, Frank Müller, MD1, Hilmar Wisplinghoff, MD1 and Oliver Cornely, MD, FACP, FIDSA, FAAM2, (1)University Hospital of Cologne, Cologne, Germany, (2)Uniklinik Koln, Cologne, Germany

Disclosures:

D. Seidel, None

L. Duran Graeff, None

M. Vehreschild, MSD/Merck: Consultant and Speaker's Bureau , Consulting fee and Speaker honorarium
Gilead Sciences: Speaker's Bureau , Speaker honorarium
Astellas Pharma: Consultant , Research Contractor and Speaker's Bureau , Consulting fee , Research support and Speaker honorarium

J. Vehreschild, Astellas Pharma: Grant Investigator and Speaker's Bureau , Consulting fee , Grant recipient , personal fees and Speaker honorarium
Gilead Sciences: Grant Investigator and Speaker's Bureau , Grant recipient and Speaker honorarium
Merck/MSD: Grant Investigator and Speaker's Bureau , Grant recipient and Speaker honorarium
Pfizer: Grant Investigator and Speaker's Bureau , Grant recipient and Speaker honorarium

B. Liss, None

P. Köhler, Astellas Pharma: Speaker's Bureau , Speaker honorarium

F. Müller, None

H. Wisplinghoff, None

O. Cornely, Astellas Pharma: Consultant , Grant Investigator and Speaker's Bureau , Consulting fee , Grant recipient and Speaker honorarium
Basilea: Consultant , Grant Investigator and Speaker's Bureau , Consulting fee , Research grant and Speaker honorarium
Gilead: Consultant , Grant Investigator and Speaker's Bureau , Consulting fee , Grant recipient and Speaker honorarium
Merck/MSD: Consultant , Grant Investigator and Speaker's Bureau , Consulting fee , Grant recipient and Speaker honorarium
Pfizer: Consultant , Grant Investigator and Speaker's Bureau , Consulting fee , Grant recipient and Speaker honorarium

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