gms | German Medical Science

18th Symposium on Infections in the Immunocompromised Host

International Immunocompromised Host Society

15. to 17.06.2014, Berlin

Invasive Fungal Infections in Patients with Myeloma in the Era of Novel Myeloma Agents

Meeting Abstract

  • B.W. Teh - Peter MacCallum Cancer Centre, Melbourne, Australia
  • J.C. Teng - Australia
  • K. Urbancic - Australia
  • A. Grigg - Australia
  • S.J. Harrison - Australia
  • L.J. Worth - Australia
  • M.A. Slavin - Australia
  • K.A. Thursky - Australia

18th Symposium on Infections in the Immunocompromised Host. Berlin, 15.-17.06.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc14ichs11

doi: 10.3205/14ichs11, urn:nbn:de:0183-14ichs117

Veröffentlicht: 3. Juni 2014

© 2014 Teh et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: Infections are a leading cause of morbidity and mortality in patients with multiple myeloma (MM). The epidemiology and outcomes of invasive fungal infection (IFI) in patients with myeloma remains undefined in the era of novel anti-myeloma therapy.

Methods: Patients with MM managed at the Peter MacCallum Cancer Centre and Austin Hospital in Victoria, Australia from 2009 to 2011 with an IFI were identified from electronic medical management, drug approval and dispensing systems. Clinical, microbiological and radiology records were reviewed for further information including patient demographics, disease (myeloma) features, risk factors for IFI, clinical features and outcomes. IFIs were categorised according to modified EORTC/MSG criteria.

Results: Of 298 patients receiving treatment for MM, 9 (3.0%) developed an IFI with 9 episodes of infection. The rate of invasive mould infection and invasive aspergillosis was 1.0% (3/298) and 0.3% (1/298) respectively. The IFI rate was 2.6% (4/152) following an autologous haematopoietic stem cell transplant (autoHCT) and it was 0.7% (1/146) for patients who have not received an autoHCT. The median age was 62 years and patients with IFI received a median of 7 lines of myeloma treatment. A majority of patients received either an immunomodulatory drug (33.3%, 3/9) or bortezomib (33.3%, 3/9) prior to the diagnosis of IFI.

Most (88.9%, 8/9) occurred during disease progression. There were 3 (33.3%) proven, 2 (22.2%) probable and 4 (44.4%) possible cases of IFI. The fungal pathogens isolated were the following; Candida albicans, Candida parapsilosis, Scedosporium prolificans (proven), Aspergillus fumigatus, and Scopulariopsis sp. (probable). The sites of involvement were disseminated (n=1), blood (n=2) and pulmonary (n=6). 44.4% (4/9) received antifungal prophylaxis with fluconazole. More than half of episodes (55.6%, 5/9) required management in the intensive care unit and 30-day mortality was 44.4%.

Conclusion: In patients with MM, IFIs occur predominantly during disease progression and are associated with significant morbidity and mortality. In light of these findings, the type and role of antifungal prophylaxis requires further evaluation.