Older patients with high-risk fungal infections can be successfully allografted using non-myeloablative conditioning in combination with intensified supportive care regimens.
Leukaemic patients with advanced disease and severe fungal infections as well as older patients with substantial co-morbidity are usually excluded from conventional allotransplantation because of increased morbidity and mortality. We approached allogeneic transplantation in four patients with a median age of 62 years (one chronic myeloid leukaemia in blast crisis, one high-risk acute myeloid leukaemia (AML) in first complete remission (CR1), one AML in 2nd relapse, one AML in CR2 with pre-existing fungal lung infections (two aspergillus, two mucor) and additional co-morbidity (diabetes n = 2, aortic aneurysm n = 1, arterial sclerosis n = 2) by combining non-myeloablative conditioning with an intensified supportive care regimen, including amphotericin B and 4-12 (median 9) prophylactic granulocyte transfusions from granulocyte colony-stimulating factor (G-CSF)-stimulated volunteer donors. G-CSF was also given to patients until neutrophil recovery. All four patients recovered to a neutrophil count of 0.5 x 109/l after a median of 11.5 d (range 11-13 d). Prophylactic granulocyte transfusions also reduced the need for platelet transfusions and minimized mucositis. All patients were discharged at a median of 25 d (range 18-59 d) and are alive and well after a median follow-up of > 390 d (range 336-417 d) without evidence of leukaemia. Regression of the fungal lesions was documented in three patients, with a slight progression detected by computerized tomography scan of the chest in one patient. We conclude that pulmonary fungal infections are not a contraindication for allogeneic stem cell transplantation, if non-myeloablative conditioning regimens are used in combination with granulocyte transfusions, intravenous amphotericin B and G-CSF.
Hermann
S
S
Department of Haematology and Oncology, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany. H.Martin@em.uni-frankfurt.de
Klein
S A
SA
Jacobi
V
V
Thalhammer
A
A
Bialleck
H
H
Duchscherer
M
M
Wassmann
B
B
Hoelzer
D
D
Martin
H
H
D000208:Acute Disease; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery; D001161:Arteriosclerosis / Q000150:complications / Q000601:surgery; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D016026:Bone Marrow Transplantation; D002452:Cell Count; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000601:surgery; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D007938:Leukemia / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery*; D007951:Leukemia, Myeloid / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D015466:Leukemia, Myeloid, Chronic-Phase / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D008172:Lung Diseases, Fungal / Q000150:complications* / Q000188:drug therapy / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology; D010976:Platelet Count; D012008:Recurrence; D012074:Remission Induction; D014057:Tomography, X-Ray Computed; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D000935:Antifungal Agents; D016179:Granulocyte Colony-Stimulating Factor; D000666:Amphotericin B