Predictors of Early and Late Mortality for Patients with Hematologic Malignancy and Invasive Mold Disease
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Clinical Management
2.3. Microbiological Methods
2.4. Data Collection
2.5. Statistical Analyses
3. Results
3.1. Survival Analyses
3.2. Early and Late Mortality
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Outcome at 12 Weeks | Log-Rank p Value | Total n = 86 | |
---|---|---|---|---|
Survival n = 45 | Death n = 41 | |||
Male Sex | 30 (66.6) | 26 (63.4) | 0.84 | 56 (65.1) |
Age, years, median (IQR) | 52 (36–66) | 51 (37–63) | 0.77 | 52 (36–66) |
Healthcare tourism | 9 (20.0) | 8 (19.5) | 0.76 | 17 (19.8) |
Charlson index, median (IQR) | 3 (2–3) | 3 (2–3) | 0.52 | 6 (7) |
Hematological Malignancy | ||||
AML | 24 (53.3) | 14 (34.1) | 0.091 | 38 (44.1) |
ALL | 8 (17.7) | 5 (12.2) | 0.39 | 13 (15.1) |
CLL | 6 (13.3) | 4 (9.7) | 0.53 | 10 (11.6) |
NHL | 7 (15.5) | 13 (31.7) | 0.091 | 20 (23.2) |
Hodgkin’s lymphoma | 1 (2.2) | 3 (7.3) | 0.031 | 4 (4.6) |
CML | 1 (2.2) | 3 (7.3) | 0.30 | 4 (4.6) |
Myeloma | 1 (2.2) | 1 (2.4) | 0.79 | 2 (2.3) |
MDS | 2 (4.4) | 3 (7.3) | 0.58 | 5 (5.8) |
Hematopoietic stem cell transplant (HSCT) | 16 (35.5) | 22 (53.6) | 0.12 | 38 (44.1) |
Allogeneic HSCT | 15 (33.3) | 16 (39.0) | 0.35 | 31 (36.0) |
Autologous HSCT | 2 (4.4) | 10 (24.3) | 0.0006 | 12 (13.9) |
Conditioning | ||||
Ablative | 15 (93.7) | 19 (86.3) | 0.36 | 34 (89.4) |
Non-ablative | 1 (6.2) | 3 (13.6) | 0.41 | 4 (10.5) |
ATG | 8 (17.7) | 12 (29.2) | 0.094 | 20 (23.2) |
Status of malignancy | ||||
Relapse/Refractory | 22 (48.8) | 30 (73.1) | 0.028 | 52 (60.4) |
Remission induction | 19 (42.2) | 8 (19.5) | 0.036 | 27 (31.4) |
Remission | 4 (8.8) | 3 (7.3) | 1.0 | 7 (8.1) |
Host Factors | ||||
Neutropenia (ANC < 500/mcL) | 40 (88.8) | 32 (78.0) | 0.12 | 72 (83.7) |
Severe neutropenia (ANC < 100/mcL) | 25 (55.5) | 25 (60.9) | 0.64 | 50 (58.1) |
Neutropenia duration (days) | 24 (14–49) | 23 (12–32) | 0.22 | 23.5 (14–40) |
GVHD | 13 (28.8) | 7 (17.0) | 0.24 | 20 (23) |
Corticosteroids | 11 (24.4) | 13 (31.7) | 0.52 | 24 (27.9) |
Calcineurin inhibitor | 19 (42.2) | 13 (31.7) | 0.28 | 32 (37.2) |
EORTC/MSG classification | ||||
Possible | 14 (31.1) | 9 (21.9) | 0.16 | 23 (26.7) |
Probable | 18 (40) | 19(46.3) | 0.08 | 37 (43.0) |
Proven | 13 (28.8) | 13 (31.7) | 0.83 | 26 (30.2) |
Fungal pathogen | ||||
Aspergillus | 25 (55.5) | 28 (68.2) | 0.26 | 53 (61.6) |
Mucorales | 4 (8.8) | 3 (7.3) | 0.59 | 7 (8.1) |
Fusarium | 2 (4.4) | 0 (0) | 0.24 | 2 (2.3) |
Site of Infection | ||||
Pulmonary | 36 (80.0) | 36 (87.8) | 0.23 | 72 (83.7) |
Sinus | 6 (13.3) | 8 (19.5) | 0.38 | 14 (16.2) |
Soft tissue | 2 (4.4) | 3 (7.3) | 0.58 | 5 (5.8) |
CNS | 1 (2.2) | 1 (2.4) | 0.79 | 2 (2.3) |
Chest CT | ||||
Angioinvasive pattern | 18 (40.0) | 15 (36.5) | 0.83 | 33 (38.3) |
Airway invasive pattern | 3 (6.6) | 2 (4.8) | 0.69 | 5 (5.8) |
Combined pattern | 12 (26.6) | 14 (34.1) | 0.38 | 26 (30.2) |
Halo sign | 8 (17.7) | 7 (17.0) | 0.97 | 15 (17.4) |
Serum GMI > 0.5 | 8 (20.0) | 17 (51.5) | 0.0033 | 25 (29) |
Maximal serum GMI, median (IQR) | 0.32 (0.2–0.46) | 0.6 (0.3–1.6) | 0.008 | 0.36 (0.28–0.7) |
BALF GMI > 1.0 | 11 (55.0) | 12 (80.0) | 0.18 | 23 (65.7) |
Initial antifungal treatment | ||||
Voriconazole | 25 (55.5) | 23 (56.1) | 0.90 | 48 (56) |
Posaconazole | 3 (6.6) | 1 (2.4) | 0.33 | 4 (4.6) |
Amphotericin B-based a | 4 (8.8) | 11 (26.8) | 0.006 | 15 (12.8) |
Echinocandin | 1 (2.2) | 1 (2.4) | 0.95 | 2 (2.3) |
Non-active drug | 8 (17.7) | 4 (9.7) | 0.30 | 12 (13.9) |
Response to treatment, 3 weeks | ||||
Full | 4 (8.8) | 1 (2.4) | 0.25 | 5 (5.8) |
Partial | 34 (75.5) | 5 (12.2) | <0.001 | 39 (45.3) |
Stable | 0 (0) | 1 (2.4) | 0.65 | 1 (1.1) |
Progression | 7 (15.5) | 34 (82.9) | <0.001 | 41 (47.7) |
Response to treatment, 6 weeks | ||||
Full | 12 (26.6) | 1 (2.4) | 0.022 | 13 (15.1) |
Partial | 22 (48.8) | 3 (7.3) | 0.001 | 25 (29.0) |
Stable | 2 (4.4) | 0 (0) | 1.0 | 2 (2.3) |
Progression | 6 (13.3) | 11 (26.8) | 0.25 | 17 (19.7) |
Variable | Early Mortality | Late Mortality | Overall Mortality |
---|---|---|---|
Lymphoma/Autologous HCT | 4.51 (1.67–12.17) | 4.06 (1.5–10.9) | |
Amphotericin B treatment | 2.33 (0.81–6.64) | 2.07 (0.76–5.60) | |
Serum GMI > 0.5 | 2.80 (1.03–7.64) | 2.9 (1.2–6.9) | |
Serum GMI > 1.5 | 11.08 (1.8–67.5) | ||
Progression at 3 weeks | 36.88 (4.79–283.87) | 706.2 (6.6–75,179.6) | |
Treatment-refractory malignancy | 8.48 (1.40–51.3) | 2.7 (1.06–6.8) |
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Yashphe, E.L.; Ram, R.; Avivi, I.; Ben-Ami, R. Predictors of Early and Late Mortality for Patients with Hematologic Malignancy and Invasive Mold Disease. J. Fungi 2021, 7, 697. https://doi.org/10.3390/jof7090697
Yashphe EL, Ram R, Avivi I, Ben-Ami R. Predictors of Early and Late Mortality for Patients with Hematologic Malignancy and Invasive Mold Disease. Journal of Fungi. 2021; 7(9):697. https://doi.org/10.3390/jof7090697
Chicago/Turabian StyleYashphe, Eva L., Ron Ram, Irit Avivi, and Ronen Ben-Ami. 2021. "Predictors of Early and Late Mortality for Patients with Hematologic Malignancy and Invasive Mold Disease" Journal of Fungi 7, no. 9: 697. https://doi.org/10.3390/jof7090697