title: High-risk AML complicated by pulmonary aspergillosis: successful treatment with nonmyeloablative stem cell transplantation and long-term administration of voriconazole.
abstract: Acute myeloid leukemia (AML) associated with central diabetes insipidus (DI) and chromosomal aberrations is characterised by a very poor prognosis. We present a 28-year-old female with AML FAB M0, preceding DI and cytogenetic abnormalities (monosomy 7 and inversion of chromosome 9). Complete remission was achieved with FLAG after she was refractory to two different induction regimens. Prolonged neutropenia resulted in invasive pulmonary aspergillosis. Allogeneic stem cell transplantation from a matched unrelated donor was performed using a reduced-intensity conditioning regimen. Desmopressin substitution for DI was withdrawn after transplant without recurrence of symptoms. Initial antifungal treatment, including liposomal amphotericin B, caspofungin and itraconazole, was replaced by voriconazole after deterioration of pulmonary aspergillosis, resulting in improvement, stabilisation and finally, also as the combined effect of discontinuation of the immunosuppressive therapy, in disappearance of signs and symptoms. Thirteen months after transplant, the patient is in continuous complete remission. The presented case study thus demonstrates that high-risk AML with concomitant invasive fungal infection may be safely and effectively treated by nonmyeloablative stem cell transplantation and long-term administration of voriconazole.
authors.affiliation: Division of Hematology-Department of Internal Medicine, Karl-Franzens-University, Auenbruggerplatz 38, 8036 Graz, Austria. margiteibl@gmx.net
authors.forename: M
authors.initials: M
authors.lastname: Eibl
authors.forename: H W
authors.initials: HW
authors.lastname: Auner
authors.forename: W
authors.initials: W
authors.lastname: Zinke-Cerwenka
authors.forename: H
authors.initials: H
authors.lastname: Sill
authors.forename: H J
authors.initials: HJ
authors.lastname: Dornbusch
authors.forename: W
authors.initials: W
authors.lastname: Linkesch
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage*; D001228:Aspergillosis / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000382:microbiology* / Q000473:pathology / Q000628:therapy*; D008172:Lung Diseases, Fungal / Q000000981:diagnostic imaging / Q000188:drug therapy*; D019653:Myeloablative Agonists / Q000627:therapeutic use; D011743:Pyrimidines / Q000008:administration & dosage*; D013902:Radiography, Thoracic; D033581:Stem Cell Transplantation; D014057:Tomography, X-Ray Computed; D019172:Transplantation Conditioning / Q000379:methods; D014230:Triazoles / Q000008:administration & dosage*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D019653:Myeloablative Agonists; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole