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Outcome predictors of 84 patients with hematologic malignancies and Fusarium infection Nucci M; Anaissie EJ; Queiroz-Telles F; Martins CA; Trabasso P; Solza C; Mangini C; Simoes BP; Colombo AL; Vaz J; Levy CE; Costa S; Moreira VA; Oliveira JS; Paraguay N; Duboc G; Voltarelli JC; Maiolino A; Pasquini R; Souza CACancer 2003[Jul]; 98 (2): 315-9BACKGROUND: Invasive infection by Fusarium sp. is associated with high mortality in patients with hematologic cancer. Yet to the authors' knowledge, little is known regarding predictors of adverse outcome. METHODS: The authors conducted a retrospective review of the records of patients with hematologic carcinoma and invasive fusariosis who were treated at one institution in the U.S. and at 11 centers in Brazil. RESULTS: The records of 84 patients were evaluated. Neutropenia was present in 83% and 33 patients had undergone stem cell transplantation. Only 18 patients (21%) were alive 90 days after the diagnosis of fusariosis. Multivariate predictors of poor outcome were persistent neutropenia (hazard ratio [HR] of 5.43; 95% confidence interval [95% CI], 2.64-11.11) and use of corticosteroids (HR of 2.18; 95% CI, 1.98-3.96). The actuarial survival rate of patients without any of these factors was 67% compared with 30% for patients who recovered from neutropenia but were receiving corticosteroids and 4% for patients with persistent neutropenia only. None of the patients with both risk factors survived (P<0.0001). CONCLUSIONS: Measures to reduce the duration of neutropenia, as well as the judicious use of corticosteroids, may reduce the high mortality rate of fusariosis in patients with hematologic cancer.|*Immunocompromised Host[MESH]|Adolescent[MESH]|Adult[MESH]|Aged[MESH]|Amphotericin B/therapeutic use[MESH]|Antifungal Agents/therapeutic use[MESH]|Child[MESH]|Child, Preschool[MESH]|Female[MESH]|Fusarium/*isolation & purification[MESH]|Hematologic Neoplasms/*complications/immunology[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Mycoses/complications/drug therapy/*mortality[MESH]|Prognosis[MESH]|Retrospective Studies[MESH]|Stem Cell Transplantation[MESH]|Survival Analysis[MESH] |
