title: Outcome predictors of 84 patients with hematologic malignancies and Fusarium infection.
abstract: BACKGROUND
  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.
authors.affiliation: Department of Internal Medicine, Hematology Service, University Hospital, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Marcio
authors.initials: M
authors.lastname: Nucci
authors.forename: Elias J
authors.initials: EJ
authors.lastname: Anaissie
authors.forename: Flavio
authors.initials: F
authors.lastname: Queiroz-Telles
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Martins
authors.forename: Plínio
authors.initials: P
authors.lastname: Trabasso
authors.forename: Cristiana
authors.initials: C
authors.lastname: Solza
authors.forename: Claudia
authors.initials: C
authors.lastname: Mangini
authors.forename: Belinda P
authors.initials: BP
authors.lastname: Simões
authors.forename: Arnaldo L
authors.initials: AL
authors.lastname: Colombo
authors.forename: Jorge
authors.initials: J
authors.lastname: Vaz
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Levy
authors.forename: Silvia
authors.initials: S
authors.lastname: Costa
authors.forename: Vaneusa A
authors.initials: VA
authors.lastname: Moreira
authors.forename: José Salvador
authors.initials: JS
authors.lastname: Oliveira
authors.forename: Nestor
authors.initials: N
authors.lastname: Paraguay
authors.forename: Gisele
authors.initials: G
authors.lastname: Duboc
authors.forename: Julio C
authors.initials: JC
authors.lastname: Voltarelli
authors.forename: Angelo
authors.initials: A
authors.lastname: Maiolino
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pasquini
authors.forename: Cármino A
authors.initials: CA
authors.lastname: Souza
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D005670:Fusarium / Q000302:isolation & purification*; D019337:Hematologic Neoplasms / Q000150:complications* / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D016019:Survival Analysis
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B