Invasive Fungal Infections (IFI) In Lymphoproliferative Disorders: Epidemiology, Outcome and Prognostic Factors

Abstract 4959

Few epidemiological data about IFI in chronic lymphoid malignancies are available in literature. Our aim is to describe epidemiology, clinical manifestations and outcome of IFI in these patients (pts). We reviewed the records of pts with lymphoproliferative disorders, treated between 2004 and 2010 for probable/proven IFI, according to the revised criteria of EORTC/MSG. We registered 40 probable/proven IFI. Twenty-five pts were affected by lymphoma, 9 by CLL, 3 by Waldenström macroglobulinemia, 2 by multiple myeloma and 1 by hairy cell leukemia. The median age was 57 years (r: 17–71). Twenty-nine pts (75%) had progressive/relapsed hematological disease, and 75% were treated with multiple lines of chemotherapy. Risk factors for IFI were: neutropenia (11 pts), previous solid organ transplant (3) or allogeneic HSCT (3), treatment with high dose steroids (3), monoclonal antibodies (MABs) such as rituximab (9) and alemtuzumab (3), nucleosidic analogues (3) or multiple of these factors (8). Regarding mortality the following factors were evaluated: deep and prolonged neutropenia, multiple lines chemotherapy, MABs and purine analogues administration, diagnosis and status of the underlying disease. Incidence of IFI was 2,7%; (moulds 2%, yeasts 0,4%, mixed infections 0,3%). We recorded 7 yeast infections: 6 were documented by cultures (3 C. albicans, 2 C. glabrata and 1 Blastoschyzomices capitatus), and 1 by the microscopic observation of Candida spp in the vitreum. Thirty pts developed an invasive mould infection (IMI); 3 of them had a proven pulmonary IMI diagnosed by histology (2 Aspergillus spp, 1 Mucor). Twenty-seven pts had a probable IMI: 24 had lung involvement, 2 a sinusal localization, and 1 a pulmonary infection disseminated to brain. Mycological criteria were more often provided by the positivity of the galactomannan antigen (GM, 14 pts) in serum and/or BAL fluid. Cultures resulted positive in 12 cases (5 A. fumigatus, 2 Aspergillus spp, 2 A. flavus, 1 A. niger, 1 Fusarium and 1 for both Scedosporium and Aspergillus); in 4 of them, both GM and culture positivity from the BAL fluid were present. Finally, we observed 3 mixed infections by both moulds and yeasts: in 2 pts a proven yeast infection with isolation in the blood culture (1 C. albicans, 1 C. glabrata) was associated to a probable IMI with the positivity of CT scan and GM; in 1 pt autopsy revealed a pneumonia by Candida spp and a disseminated infection by Aspergillus spp. Eight of 40 pts died due to infection, but only in one pt IFI was the unique cause of death. IFI attributable mortality rate was 20%. At the univariate analysis, the only risk factor related to mortality was the administration of multiple lines of chemotherapies (p 0.04).