1
|
Bernardez B, Mangues Bafalluy I, Martínez Callejo V, Fernández Ávila JJ, Marcos Rodríguez JA, Parada Aradilla MA, Martínez Bautista MJ. Risk stratification model for the pharmaceutical care of oncology patients with solid or hematologic neoplasms. Farm Hosp 2024:S1130-6343(23)00943-1. [PMID: 38461113 DOI: 10.1016/j.farma.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 03/11/2024] Open
Abstract
OBJECTIVE We aimed to develop of a risk stratification model for the pharmaceutical care (PC) of patients with solid or hematologic neoplasms who required antineoplastic agents or supportive treatments. METHOD The risk stratification model was collaboratively developed by oncology pharmacists from the Spanish Society of Hospital Pharmacy (SEFH). It underwent refinement through three workshops and a pilot study. Variables were defined, grouped into four dimensions, and assigned relative weights. The pilot study collected and analyzed data from participating centers to determine priority levels and evaluate variable contributions. The study followed the Kaiser Permanente pyramid model, categorizing patients into three priority levels: Priority 1 (intensive PC, 90th percentile), Priority 2 (60th-90th percentiles), and Priority 3 (60th percentile). Cut-off points were determined based on this stratification. Participating centers recorded variables in an Excel sheet, calculating mean weight scores for each priority level and the total risk score. RESULTS The participants agreed to complete a questionnaire that comprised 22 variables grouped into 4 dimensions: demographic (maximum score =11); social and health variables and cognitive and functional status (maximum = 19); clinical and health services utilization (maximum = 25); and treatment-related (maximum = 41). From the results of applying the model to the 199 patients enrolled, the cutoff points for categorization were 28 or more points for priority 1, 16 to 27 points for priority 2 and less than 16 for priority 3; more than 80% of the total score was based on the dimensions of 'clinical and health services utilization' and 'treatment-related'. Interventions based on the pharmaceutical care model were recommended for patients with solid or hematological neoplasms, according to their prioritization level. CONCLUSION This stratification model enables the identification of cancer patients requiring a higher level of pharmaceutical care and facilitates the adjustment of care capacity. Validation of the model in a representative population is necessary to establish its effectiveness.
Collapse
Affiliation(s)
- Beatriz Bernardez
- Departamento de Medicina, Universidad de Santiago de Compostela, Santiago de Compostela, España; Unidad de Farmacia Oncológica, Servicio de Farmacia, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España; Grupo de Farmacología, Instituto de Investigación Santiago de Compostela (IDIS), Santiago de Compostela, España.
| | - Irene Mangues Bafalluy
- Servicio de Farmacia, Hospital Universitario Arnau de Vilanova de Lleida, Lleida, España; Grupo de Farmacoepidemiología y Farmacodinamia, Institut de Recerca Biomèdica, IRBLleida, Lleida, España
| | - Virginia Martínez Callejo
- Unidad de Farmacia Oncológica, Servicio de Farmacia, Hospital Universitario Marqués de Valdecilla, Santander, España
| | | | | | | | | |
Collapse
|
2
|
Angarola E, Peuchot VA, Warley F, Liberatore DI. Secondary hypogammaglobulinemia in adults-A large retrospective cohort study. Med Clin (Barc) 2024; 162:170-178. [PMID: 37980212 DOI: 10.1016/j.medcli.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND AND OBJECTIVE IgG replacement therapy (IgG-RT) has radically changed the clinical evolution of primary immunodeficiencies, yet the information regarding secondary hypogammaglobulinemia (SHG) is insufficient or conflicting. We aim to describe clinical features, evolution and treatment of SHG patients in our center. METHODS Dynamic retrospective cohort between January 2001 and July 2021 of adults with gamma globulin fraction <0.6g/dL in a serum protein electrophoresis and a coincident decrease of IgG levels - with a disease-related SHG or treatment that reduces serum immunoglobulins. RESULTS We included 1012 patients with SHG with a median follow-up of 5 years (IQR 2-8). Hematological diseases were identified in 95% of the patients and 61% received drugs related to SHG. Sixty five percent had more than one etiological factor associated with SHG. Infectious diseases were present in 69% of the patients, 48% had respiratory infections and 17% had severe infections. There was statistical association between respiratory and severe infections with multiple myeloma (MM), lymphoma and rituximab. MGUS had less infections and death compared with other etiologies. IgG-RT was indicated in 18.7% of the patients and 4.6% received it for more than 6 months with variable intervals. Among the latter group, there was a significant reduction of all-type infections and respiratory infections with IgG-RT (p<0.001), and it was consistent with similar findings in lymphoma, MM and all IgG levels subgroups. CONCLUSION SHG was associated with more than one etiological factor and a high frequency of infections. IgG-RT indication was irregular yet still effective. It is relevant to consider IgG levels screening, monitoring and accurate indication of IgG-RT.
Collapse
Affiliation(s)
- Ernestina Angarola
- Internal Medicine Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | | | - Fernando Warley
- Hematology Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | |
Collapse
|
3
|
Pardo Lledias J, Martín Millán M, Mazariegos Cano JA, Aimar Marco C, Arias Martínez N, San Pedro Careaga B, Urizar Ursua E, Insua García MC, Lavin Gómez BA, Hernández Hernández JL. Incidental detection of raised serum levels of vitamin B12 and its association with neoplasms. Rev Clin Esp 2024; 224:10-16. [PMID: 38065526 DOI: 10.1016/j.rceng.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/10/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND AND OBJECTIVES Elevated serum levels of vitamin B12 have been associated with oncohematological diseases. However, the relevance of its incidental detection in subjects without a previous diagnosis of cancer is unknown. The aim of this study was to evaluate the relationship between incidental hypercobalaminemia (vitamin B12 > 1000 pg/mL) and the diagnosis of a tumor process in patients without a diagnosis and to establish the risk factors. MATERIAL AND METHODS Retrospective observational study of a cohort of patients with hypercobalaminemia. The incidence of neoplasms was compared with a cohort of patients with vitamin B12 levels <1000 pg/mL. RESULTS Vitamin B12 determinations of 4800 subjects were selected. Of them, 345 (7.1%) had levels >1000 pg/mL. 68 (28.4%) were excluded due to exogenous administration, 12 (5%) due to insufficient data and 15 (3%) due to having an active neoplasia, selecting 250 patients, with a median follow-up of 22 (IQR 12-39) months. Structural liver disease was detected in 59 (23.6%). 18.2% (44 patients) had solid organ cancer and 17 (7.1%) had malignant hemopathy. The average time from the detection of hypercobalaminemia to the diagnosis of cancer was about 10 months. The median until the diagnosis of neoplasia was higher in the high vitamin B12 group (13 vs. 51 months p < 0.001). Hypercobalaminemia (HR 11.8; 95% CI 2.8-49.6; p = 0.001) and smoking (HR 4.0; 95% CI, 2.15-7.59; p < 0.001) were independent predictors of neoplasia in the multivariate analysis. CONCLUSIONS Incidental detection of serum vitamin B12 levels >1000 pg/mL is high in the population. The diagnosis of solid organ and hematological neoplasia is frequent during the following year of follow-up, with hypercobalaminemia and smoking being predictors of a higher risk of cancer.
Collapse
Affiliation(s)
- J Pardo Lledias
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain.
| | - M Martín Millán
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain
| | - J A Mazariegos Cano
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain
| | - C Aimar Marco
- Servicio de Pediatría, Hospital Universitario Araba, Gasteiz, Spain
| | | | - B San Pedro Careaga
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain
| | - E Urizar Ursua
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain
| | - M C Insua García
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain
| | - B A Lavin Gómez
- Servicio de Análisis Clínico, Hospital Unversitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - J L Hernández Hernández
- Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain
| |
Collapse
|
4
|
Santarelli IM, Manzella DJ, Gallo Vaulet ML, Rodríguez Fermepín M, Crespo Y, Toledo Monaca S, Dobarro M, Fernández SI. Cycle threshold predicted mortality in a cohort of patients with hematologic malignancies infected with SARS-CoV-2. Rev Argent Microbiol 2023; 55:246-250. [PMID: 37208258 PMCID: PMC10130324 DOI: 10.1016/j.ram.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 02/13/2023] [Accepted: 03/30/2023] [Indexed: 05/21/2023] Open
Abstract
When a SARS-CoV-2 RT-qPCR test is performed, it may determine an indirect measure of viral load called cycle threshold (Ct). Respiratory samples with Ct <25.0 cycles are considered to contain a high viral load. We aimed to determine whether SARS-CoV-2 Ct at diagnosis could predict mortality in patients with hematologic malignancies (lymphomas, leukemias, multiple myeloma) who contracted COVID-19. We included 35 adults with COVID-19 confirmed by RT-qPCR performed at diagnosis. We evaluated mortality due to COVID-19 rather than mortality due to the hematologic neoplasm or all-cause mortality. Twenty-seven (27) patients survived and 8 died. The global mean Ct was 22.8 cycles with a median of 21.7. Among the survivors, the mean Ct was 24.2, and the median Ct value was 22.9 cycles. In the deceased patients, the mean Ct was 18.0 and the median Ct value was 17.0 cycles. Using the Wilcoxon Rank Sum test, we found a significant difference (p=0.035). SARS-CoV-2 Ct measured in nasal swabs obtained at diagnosis from patients with hematologic malignancies may be used to predict mortality.
Collapse
Affiliation(s)
- Ignacio Martín Santarelli
- Universidad de Buenos Aires, Hospital de Clínicas "José de San Martín", Departamento de Medicina, Buenos Aires, Argentina; Universidad de Buenos Aires, Facultad de Medicina, Buenos Aires, Argentina.
| | | | - María Lucía Gallo Vaulet
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Bioquímica Clínica, Cátedra de Microbiología Clínica, Inmunología y Virología Clínica, Buenos Aires, Argentina; Universidad de Buenos Aires, Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Buenos Aires, Argentina
| | - Marcelo Rodríguez Fermepín
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Departamento de Bioquímica Clínica, Cátedra de Microbiología Clínica, Inmunología y Virología Clínica, Buenos Aires, Argentina; Universidad de Buenos Aires, Instituto de Fisiopatología y Bioquímica Clínica (INFIBIOC), Buenos Aires, Argentina
| | | | | | - Martín Dobarro
- Sanatorio Sagrado Corazón, Buenos Aires, Argentina; Universidad de Buenos Aires, Hospital de Clínicas "José de San Martín, Departamento de Medicina, Programa de Hospital de Día, Buenos Aires, Argentina
| | - Sofía Isabel Fernández
- Universidad de Buenos Aires, Hospital de Clínicas "José de San Martín", Departamento de Medicina, Buenos Aires, Argentina; Universidad de Buenos Aires, Facultad de Medicina, Buenos Aires, Argentina
| |
Collapse
|
5
|
Bernardi RM, Holler SR, Almeida EGCD, Anton C, Machado FD, Silva DR. Evaluation of the diagnostic accuracy of galactomannan from the bronchoalveolar lavage fluid of patients with suspected invasive pulmonary aspergillosis. Rev Iberoam Micol 2022; 39:31-35. [PMID: 35461766 DOI: 10.1016/j.riam.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/16/2021] [Accepted: 07/21/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Several studies to evaluate the accuracy of galactomannan (GM) in bronchoalveolar lavage fluid (BALF) as a diagnostic tool have been carried out; however, there are still controversies about the optimal cut-off point of BALF GM. AIMS The objective of this study was to determine the diagnostic accuracy and the optimal cut-off point on BALF GM from patients with suspected invasive pulmonary aspergillosis (IPA) in a tertiary care hospital. METHODS A cross-sectional study with 188 patients (≥18 years) that had undergone a bronchoscopy with BAL due to suspected IPA was carried out. IPA was diagnosed according to the EORTC/MSG guidelines. RESULTS The optimal optical density cut-off point for BALF GM was 0.67, with sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 70%, 32.3%, and 100%, respectively. CONCLUSIONS BALF GM detection proved to be a useful supplementary technique in the early diagnosis of IPA in both neutropenic and non-neutropenic patients.
Collapse
Affiliation(s)
- Rafaela Manzoni Bernardi
- Programa de Pós-Graduação em Ciências Pneumológicas da Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
| | | | | | - Camila Anton
- Programa de Pós-Graduação em Ciências Pneumológicas da Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Hospital de Clínicas de Porto Alegre, Brazil
| | - Felipe Dominguez Machado
- Programa de Pós-Graduação em Ciências Pneumológicas da Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Hospital de Clínicas de Porto Alegre, Brazil
| | - Denise Rossato Silva
- Programa de Pós-Graduação em Ciências Pneumológicas da Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Brazil; Hospital de Clínicas de Porto Alegre, Brazil.
| |
Collapse
|
6
|
García-Vidal C, Vázquez L, Jarque I. [Relevance of liposomal amphotericin B in the treatment of invasive fungal infections in patients with hematologic malignancies]. Rev Iberoam Micol 2021; 38:61-67. [PMID: 33994104 DOI: 10.1016/j.riam.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/18/2021] [Accepted: 03/25/2021] [Indexed: 12/20/2022] Open
Abstract
Liposomal amphotericin B (L-AmB) has been a key cornerstone for the management of invasive fungal infections (IFI) caused by a wide array of molds and yeasts during the last three decades. Multiple studies performed over this period have generated a large body of evidence on its efficacy and safety, becoming the main antifungal agent in the management of IFI in patients with hematologic malignancies in several not mutually exclusive clinical settings. First, L-AmB is the most commonly used antifungal agent in patients undergoing intensive chemotherapy for acute leukemia and high-risk myelodysplastic syndrome, as well as in hematopoietic stem cell transplant recipients. Additionally, due to the administration of newer targeted therapies (such as monoclonal antibodies or small molecule inhibitors), opportunistic mold infections are increasingly being reported in patients with hematologic malignancies usually considered low-risk for IFI. These agents usually have a high drug-drug interaction potential, being triazoles, commonly used for antifungal prophylaxis, included. Finally, patients developing breakthrough IFI because of either subtherapeutic concentrations of antifungal prophylactic drugs in blood or selection of resistant strains, require broad spectrum antifungal therapy, usually with an antifungal of a different class. In both situations, L-AmB remains as the best option for early antifungal therapy.
Collapse
Affiliation(s)
| | - Lourdes Vázquez
- Servicio de Hematología, Hospital Universitario, Salamanca, España
| | - Isidro Jarque
- Servicio de Hematología, Hospital Universitario y Politécnico La Fe, Valencia, España.
| |
Collapse
|
7
|
Torrent A, Ferrá C, Morgades M, Jiménez MJ, Sancho JM, Vives S, Batlle M, Moreno M, Xicoy B, Oriol A, Ibarra G, Ribera JM. Second neoplasms in adult patients submitted to haematopoietic stem cell transplantation. Med Clin (Barc) 2018; 150:421-7. [PMID: 28874263 DOI: 10.1016/j.medcli.2017.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/04/2017] [Accepted: 07/09/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Patients submitted to haematopoietic stem cell transplantation (HSCT) are at increased risk of late complications, such as second neoplasm (SN). The incidence and risk factors of SN in patients receiving HSCT at a single centre were analysed. PATIENTS AND METHODS The follow-up of adult patients who received a first HSCT (autologous [auto-HSCT] or allogeneic [allo-HSCT]) between January 2000 and December 2015 was reviewed. We collected their demographic characteristics, the primary disease and type of HSCT, and analysed the cumulative incidence of SN and their risk factors. RESULTS Of 699 transplanted patients (auto-HSCT, n=451; allo-HSCT, n=248), 42 (6%) developed SN (17 haematological and 25 solid), 31 post-auto-HSCT and 11 post-allo-HSCT. Haematologic SN were more frequent after auto-HSCT than after allo-HSCT. The median time between HSCT and SN was 4.09 years [range 0.07-13.15], with no differences between auto-HSCT and allo-HSCT. The cumulative incidence of SN was 5% (95% CI 3-6) at 5 years, 7% (95% CI 5-10) at 10 years and 11% (95% CI 8-15) at 15 years, without differences according to the type of HSCT. Only the age over 40 years correlated with an increased risk of SN. CONCLUSIONS In this series, the incidence of post-HSCT SN was similar to that previously described. Patients submitted to an auto-HSCT showed a higher frequency of haematologic SN. A higher incidence of SN was detected in patients older than 40 at the time of HSCT.
Collapse
|
8
|
Ortega-Ortega M, Montero-Granados R, Jiménez-Aguilera JDD. Differences in the economic valuation and determining factors of informal care over time: the case of blood cancer. Gac Sanit 2017; 32:411-417. [PMID: 28529098 DOI: 10.1016/j.gaceta.2017.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/26/2017] [Accepted: 02/06/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To estimate differences in the economic valuation and sociodemographic and clinical factors associated with informal care between phases of the treatment in the case of blood cancer patients. METHODS 139 haematological cancer patients who underwent a stem cell transplantation completed a longitudinal questionnaire according to 3 phases of the treatment: short-term (pre-transplant), medium-term (1st year post-transplant) and long-term (2nd-6th year post-transplant). Economic value of informal care was estimated using proxy good and opportunity cost methods. Ordered and binary logistic models were performed to identify factors associated with informal care. RESULTS 123 patients reported having received informal care. A progressive reduction of the number of hours of care was observed between phases. Monetary value per patient ranged from 1,288 to 3,409; 1,045 to 2,786; and 336 to 854 €/month in the short, medium and long term, respectively. Patients with acute leukaemia and those who received an unrelated allogeneic transplantation were 22% (short-term) and 33.5% (medium-term) more likely to receive more than 8hours/day of care respect to patients diagnosed with lymphoma and autologous transplantation. In the long term, patients with multiple myeloma were more likely to receive more care. Better health status and higher educational level were associated with fewer daily hours of care. CONCLUSIONS Informal care varies greatly between stages of the treatment depending on the clinical and sociodemographic factors. Significant caring time and societal costs are associated with such care in blood cancer patients.
Collapse
Affiliation(s)
- Marta Ortega-Ortega
- Applied Economic Department, School of Economic and Business, University of Granada, Granada, Spain.
| | - Roberto Montero-Granados
- Applied Economic Department, School of Economic and Business, University of Granada, Granada, Spain
| | | |
Collapse
|
9
|
Calvillo Batllés P, Carreres Polo J, Sanz Caballer J, Salavert Lletí M, Compte Torrero L. Hematologic neoplasms: interpreting lung findings in chest computed tomography. Radiologia 2015; 57:455-70. [PMID: 26315258 PMCID: PMC7127573 DOI: 10.1016/j.rx.2015.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 06/26/2015] [Accepted: 07/04/2015] [Indexed: 12/21/2022]
Abstract
La patología pulmonar en la historia de un paciente con neoplasia hematológica es muy frecuente y variable en función de la enfermedad de base y la terapia recibida. La morbimortalidad asociada es alta, por lo que requiere un tratamiento correcto y precoz. La tomografía computarizada (TC) torácica, junto con el análisis de muestras biológicas, son las herramientas de diagnóstico de primera línea empleadas en estos pacientes, y en determinados casos se requieren métodos invasivos. La interpretación de las imágenes exige el análisis de un contexto clínico en muchas ocasiones complejo. Partiendo del conocimiento que adquiere el radiólogo en su formación sobre el diagnóstico diferencial de los hallazgos pulmonares, el objetivo de este trabajo es explicar los aspectos clínicos y radiológicos claves que permiten orientar correctamente el diagnóstico y asimilar el papel actual de la TC en la estrategia terapéutica de este grupo de enfermos.
Collapse
Affiliation(s)
- P Calvillo Batllés
- Servicio de Radiología, Hospital Politècnic i Universitari La Fe, Valencia, España.
| | - J Carreres Polo
- Servicio de Radiología, Hospital Politècnic i Universitari La Fe, Valencia, España
| | - J Sanz Caballer
- Servicio de Hematología, Hospital Politècnic i Universitari La Fe, Valencia, España
| | - M Salavert Lletí
- Unidad de Enfermedades Infecciosas, Hospital Politècnic i Universitari La Fe, Valencia, España
| | - L Compte Torrero
- Servicio de Neumología, Hospital Politècnic i Universitari La Fe, Valencia, España
| |
Collapse
|
10
|
García-Ruiz JC, Olazábal I, Adán Pedroso RM, López-Soria L, Velasco-Benito V, Sánchez-Aparicio JA, Navajas A, Montejo M, Moragues MD. Disseminated fusariosis and hematologic malignancies, a still devastating association. Report of three new cases. Rev Iberoam Micol 2015; 32:190-6. [PMID: 25936697 DOI: 10.1016/j.riam.2014.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 11/12/2014] [Accepted: 11/21/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Fungi of the genus Fusarium are primarily plant pathogens and saprobes that produce disseminated infections in immunologically deficient humans. After aspergillosis, disseminated fusariosis is the second most common cause of invasive infection by filamentous fungi in patients with hematologic malignancies or those undergoing transplants of hematopoietic progenitors. AIMS Disseminated fusariosis (DF) is considered an extremely rare infection and has reached a stable incidence rate, but its high mortality rate and the lack of an optimal management protocol have raised increasing interest in this mycosis. METHODS We present three cases of DF produced by Fusarium oxysporum species complex, Fusarium solani species complex and the highly unusual Fusarium dimerum in patients with advanced hematological malignancies diagnosed in our hospital between 2007 and 2011. The species level identification of the Fusarium isolates was established by sequencing their TEF1 gene. RESULTS The isolates showed low susceptibility to most of the antifungal agents analyzed, except that observed for F. dimerum to amphotericin B (AmB) and terbinafine, and F. oxysporum species complex to AmB. Interestingly, the strain of F. solani species complex exhibited high MIC values for AmB and voriconazole, notwithstanding these drugs were used for treatment with good results. Other relevant aspects to be considered in the treatment of DF are surgically cleaning foci of infection, withdrawing presumably contaminated catheters and recovery from neutropenia. CONCLUSIONS The prevention of infection in colonized patients, the maintenance of a high level of diagnostic suspicion for early diagnosis, and the combined, vigorous and prolonged use of L-AmB and voriconazole are essential to decrease the mortality rate of this devastating infection.
Collapse
Affiliation(s)
- Juan Carlos García-Ruiz
- Servicio de Hematología y Hemoterapia, BioCruces Health Research Institute, Hospital Universitario Cruces, Plaza de Cruces s/n, 48903 Barakaldo, Bizkaia, Spain
| | - Iñigo Olazábal
- Servicio de Hematología y Hemoterapia, BioCruces Health Research Institute, Hospital Universitario Cruces, Plaza de Cruces s/n, 48903 Barakaldo, Bizkaia, Spain
| | - Rosa María Adán Pedroso
- Servicio de Pediatría, BioCruces Health Research Institute, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Leyre López-Soria
- Servicio de Microbiología, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Verónica Velasco-Benito
- Servicio de Anatomía Patológica, BioCruces Health Research Institute, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | | | - Aurora Navajas
- Servicio de Pediatría, BioCruces Health Research Institute, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Miguel Montejo
- Unidad de Enfermedades Infecciosas, Hospital Universitario Cruces, BioCruces Health Research Institute, Universidad del País Vasco (UPV/EHU), Barakaldo, Bizkaia, Spain
| | - María-Dolores Moragues
- Departamento de Enfermería, Escuela de Enfermería, Universidad del País Vasco UPV/EHU, Leioa, Bizkaia, Spain.
| |
Collapse
|
11
|
Montesinos P, Rodríguez-Veiga R, Martínez-Cuadrón D, Boluda B, Navarro I, Vera B, Alonso CM, Sanz J, López-Chulia F, Martín G, Jannone R, Sanz G, Lancharro A, Cano I, Palau J, Lorenzo I, Jarque I, Salavert M, Ramírez P, Sanz MÁ. Treatment of invasive fungal disease using anidulafungin alone or in combination for hematologic patients with concomitant hepatic or renal impairment. Rev Iberoam Micol 2015; 32:185-9. [PMID: 25858598 DOI: 10.1016/j.riam.2014.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/16/2014] [Accepted: 10/21/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Invasive fungal disease (IFD) treatment is challenging in hematologic patients due to drug interactions and toxicities that limit the use of the antifungal agents. AIMS To analyze retrospectively in terms of safety and potential efficacy anidulafungin therapy, alone or in combination. METHODS Our institutional guidelines recommended anidulafungin treatment in hematologic patients with suspected IFD and concomitant renal or liver impairment (to avoid drug interactions and preserve organ function). RESULTS From 2008 to 2013, 24 episodes of IFD occurring in 21 patients were classified as proven (4 cases), probable (15 cases) and possible (5 cases). Anidulafungin was administered alone (13%) or in combination (88%). Eight (33%) episodes were resolved, using monotherapy (1 out of 3, 33%) or a combined therapy (7 out of 21, 33%). Twelve cases (50%) were registered as failure (death due to IFD progression in 4 patients, and treatment change due to lack of efficacy in 8), and 4 cases (17%) were not evaluable (death unrelated to the IFD). Anidulafungin was not withdrawn in any case due to toxicity. CONCLUSIONS Anidulafungin therapy, alone or in combination, could be considered in hematologic patients with IFD and concomitant liver or renal impairment. Due to the low number of patients, we cannot draw any conclusion about efficacy.
Collapse
Affiliation(s)
- Pau Montesinos
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain.
| | | | | | - Blanca Boluda
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Inés Navarro
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Belen Vera
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Carmen M Alonso
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Jaime Sanz
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | | | - Guillermo Martín
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Rosa Jannone
- Intensive Care Unit Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Guillermo Sanz
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Aima Lancharro
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Isabel Cano
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Javier Palau
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Ignacio Lorenzo
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Isidro Jarque
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Miguel Salavert
- Infectious Diseases Unit of the Hospital Universitario La Fe, Valencia, Spain
| | - Paula Ramírez
- Intensive Care Unit Department of the Hospital Universitario La Fe, Valencia, Spain
| | - Miguel Ángel Sanz
- Hematology Department of the Hospital Universitario La Fe, Valencia, Spain
| |
Collapse
|
12
|
Abstract
Invasive mould infections (IMI) are a persistent problem with high morbidity and mortality rates among patients receiving chemotherapy for hematological malignancies and hematopoietic stem cell transplant recipients. Management of IMI in this setting has become increasingly complex with the advent of new antifungal agents and diagnostic tests, which have resulted in different therapeutic strategies (prophylactic, empirical, pre-emptive, and directed). A proper assessment of the individual risk for IMI appears to be critical in order to use the best prophylactic and therapeutic approach and increase the survival rates. Among the available antifungal drugs, the most frequently used in the hematologic patient are fluconazole, mould-active azoles (itraconazole, posaconazole and voriconazole), candins (anidulafungin, caspofungin and micafungin), and lipid formulations of amphotericin B. Specific recommendations for their use, and criteria for selecting the antifungal agents are discussed in this paper.
Collapse
Affiliation(s)
- Isabel Ruiz-Camps
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, España.
| | - Isidro Jarque
- Servicio de Hematología, Hospital Universitario y Politécnico La Fe, Valencia, España
| |
Collapse
|