Outcomes of patients with invasive fusariosis who undergo further immunosuppressive treatments, is there a role for secondary prophylaxis?

Marcio Nucci, Shmuel Shoham, Edson Abdala, Nelson Hamerschlak, Juan Carlos Rico, Fabio Forghieri, Simone A. Nouér, Paola Cappellano, Cristiana Solza, Yung Gonzaga, Giampaolo Nadali, Fabio Nucci, Arnaldo L. Colombo, Ana Munhoz Albuquerque, Flavio Queiroz-Telles Filho, Carlos B.L. Lima, Celso Arrais-Rodrigues, Vanderson Rocha, Francisco M. Marty

Research output: Contribution to journalArticle

Abstract

Background: Patients treated for invasive aspergillosis may relapse during subsequent periods of immunosuppression and should receive secondary prophylaxis. Little is known about the frequency of relapse and practices of secondary prophylaxis for invasive fusariosis (IF). Objectives: Evaluate practices of secondary prophylaxis and the frequency of relapse in patients who survived IF and were exposed to subsequent periods of immunosuppression. Methods: Multicentre retrospective study of patients with haematological malignancies who developed IF, survived the initial fungal disease period, and were exposed to subsequent periods of immunosuppression. Results: Among 40 patients, 35 received additional chemotherapy and developed neutropenia (median, 24 days; range, 4-104), and five received glucocorticoids for the treatment of graft-vs-host disease. Overall, 32 patients received secondary prophylaxis (voriconazole in 24) for a median of 112 days (range, 12-468). IF relapsed in five patients (12.5%): 2/8 (25%) not on prophylaxis and 3/32 (9.4%) receiving prophylaxis. Among 28 patients with disseminated IF, relapse occurred in 2/2 (100%) not on prophylaxis and in 3/26 (11.5%) on prophylaxis (P = 0.03). All patients who relapsed IF died. Conclusions: Patients with IF who survive the initial disease may relapse if exposed to subsequent episodes of immunosuppressive therapies. Secondary prophylaxis should be considered, especially if IF was disseminated.

Original languageEnglish (US)
Pages (from-to)413-417
Number of pages5
JournalMycoses
Volume62
Issue number5
DOIs
StatePublished - May 1 2019

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Keywords

  • fusariosis
  • Fusarium
  • prophylaxis
  • relapse
  • secondary prophylaxis

ASJC Scopus subject areas

  • Dermatology
  • Infectious Diseases

Cite this

Nucci, M., Shoham, S., Abdala, E., Hamerschlak, N., Rico, J. C., Forghieri, F., Nouér, S. A., Cappellano, P., Solza, C., Gonzaga, Y., Nadali, G., Nucci, F., Colombo, A. L., Albuquerque, A. M., Queiroz-Telles Filho, F., Lima, C. B. L., Arrais-Rodrigues, C., Rocha, V., & Marty, F. M. (2019). Outcomes of patients with invasive fusariosis who undergo further immunosuppressive treatments, is there a role for secondary prophylaxis? Mycoses, 62(5), 413-417. https://doi.org/10.1111/myc.12901