Successful treatment of hepatosplenic candidiasis through repeated cycles of chemotherapy and neutropenia.
BACKGROUND
Hepatosplenic candidiasis (HSC) or chronic disseminated candidiasis is an increasingly recognized problem in patients with cancer. Whether patients with HSC should continue to receive antineoplastic therapy, which may cause neutropenia with the risk for progressive HSC or breakthrough fungemia, can be a major dilemma. Patients with HSC at the National Cancer Institute continue antineoplastic therapy, when possible during antifungal therapy for HSC, despite repeated bouts of neutropenia. Therefore, whether this strategy resulted in breakthrough fungemia or progression of HSC was investigated.


METHODS
All patients consecutively treated at the National Cancer Institute at the Warren-Grant Magnuson Clinical Center from 1982-1992 for HSC were prospectively studied for therapeutic and outcome variables of antifungal and antineoplastic management. Each case was summarized on a time-event line to quantify the duration of simultaneous periods of antineoplastic therapy and antifungal therapy (AFT).


RESULTS
Sixteen patients (median age, 22 years) with HSC were studied. Eleven patients had relapsed tumor and 5 had newly diagnosed tumor. During antifungal therapy for HSC, 12 of 16 patients were neutropenic for a median of 10 days (range, 6-91 days) and 11 were profoundly neutropenic for a median of 13 days (range, 1-55 days). Hepatosplenic candidiasis was successfully treated with complete antifungal response in 12 patients and a partial response in 2; 2 patients continued to receive AFT. No patient had breakthrough fungemia and two patients had progression of HSC, only one episode of which occurred during neutropenia.


CONCLUSIONS
Hepatosplenic candidiasis in patients with cancer may be treated successfully under careful observation through repeated courses of chemotherapy-induced neutropenia without progression of hepatosplenic candidiasis or breakthrough fungemia.
Walsh
T J
TJ
Infectious Diseases Section, National Cancer Institute, Bethesda, Maryland 20892, USA.
Whitcomb
P O
PO
Revankar
S G
SG
Pizzo
P A
PA
D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D002177:Candidiasis / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D016469:Fungemia / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008107:Liver Diseases / Q000188:drug therapy / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009316:National Institutes of Health (U.S.); D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D009369:Neoplasms / Q000188:drug therapy; D009503:Neutropenia / Q000139:chemically induced*; D009894:Opportunistic Infections / Q000188:drug therapy; D011446:Prospective Studies; D012074:Remission Induction; D012307:Risk Factors; D013158:Splenic Diseases / Q000188:drug therapy / Q000382:microbiology*; D016896:Treatment Outcome; D014481:United States
D000935:Antifungal Agents