ABSTRACT
The emergence of new antifungal compounds with alternative mechanisms of action and improved tolerability has opened up new therapeutic possibilities for the use of combined antifungal treatment in life-threatening systemic fungal infections. A case report of an 8-year-old allogeneic stem cell transplant recipient who developed a central venous catheter tunnel infection caused by Aspergillus flavus is presented here. In spite of conventional and subsequent liposomal amphotericin B therapy the infection progressed rapidly and the necrosis extended further to the thoracic wall, pleura and the right lung. Combined treatment consisting of liposomal amphotericin B and caspofungin was instituted. After 30 days of dual therapy the deep fungal infection resolved and the extensive soft tissue defect showed scarring. One year post-transplant, the patient is well, with normal bone marrow function and full donor chimerism. Although there is limited clinical data on the effectiveness of echinocandins in pediatric patients with documented invasive fungal infections, this case report shows that combining liposomal amphotericin B with caspofungin could be advantageous.
Subject(s)
Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Aspergillosis/drug therapy , Aspergillus flavus/isolation & purification , Bone Marrow Transplantation , Peptides, Cyclic/therapeutic use , Postoperative Complications/drug therapy , Salvage Therapy , Amphotericin B/administration & dosage , Anemia, Aplastic/etiology , Anemia, Aplastic/surgery , Antifungal Agents/administration & dosage , Caspofungin , Catheterization, Central Venous/adverse effects , Child , Cicatrix/etiology , Disease Progression , Drug Synergism , Drug Therapy, Combination , Echinocandins , Equipment Contamination , Female , Hepatitis/complications , Humans , Immunocompromised Host , Leukocyte Transfusion , Lipopeptides , Liposomes , Necrosis , Peptides, Cyclic/administration & dosage , Pneumothorax/complications , Remission Induction , Torque teno virus/isolation & purification , Transplantation, HomologousABSTRACT
INTRODUCTION: Treatment outcome in patients with acute myeloid leukemia are determined by prognostic factors. AIM AND METHODS: Between January 1996 and December 2001 160 patients were treated with newly diagnosed acute myeloid leukemia. Treatment results were analysed according to the age and cytogenetics. Different types of induction and postremission protocols were applied. The median age was 42.2 +/- 12.8 (16-60) years. RESULTS: Complete remission was reached in 113 (70.6%) patients. 25/160 (15.6%) individuals were refractory to treatment, 22/160 (13.8%) patients died within one month. One hundred and ten out of 113 who went into remission were given postremission therapy. Twelve out of 50 relapsed patients achieved a second complete remission. The complete remission rate and cumulative survival of patients below the age of forty years were significantly higher than of those above the age of 40 years. Four fifths of refractory patients as well as nearly all patients with secondary leukemia were older than 40 years. Similarly to studies published in the literature, the expected survival was the best in patients who had a favourable cytogenetics. In contrast, all patients who fell into the unfavourable cytogenetic group died within three years. Intensification of the postremission treatment resulted in an improved survival. CONCLUSION: Classification of acute myeloid leukemia and careful determination of prognostic factors are necessary at the time of diagnosis. This predicts outcome, as well as provides means for application of individualized therapy.
