Chronic disseminated candidiasis in patients with acute leukemia: emphasis on diagnostic definition and treatment.
BACKGROUND
Chronic disseminated candidiasis (CDC) is a form of invasive fungal infection that occurs most commonly in patients with acute leukemia treated with chemotherapy. Recent studies have provided evidence for diagnostic alternatives to invasive procedures and more therapeutic options for the management of this complication. In order to put diagnostic criteria and methodological approach to the disease into the perspective of developing strategies for therapy, all relevant studies published in the English literature over the last 30 years were examined.


METHODS
The English-language articles located through MEDLINE (1966 to present) and from selected bibliographies.


RESULTS
There is increased recognition of CDC as complication of treatment with chemotherapy in patients with acute leukemia. Liver biopsy may not always be revealing or feasible to perform in some patients. Among the imaging modalities, magnetic resonance imaging has obtained preeminence as a non-invasive tool for the diagnosis of hepatosplenic fungal infections. Administration of amphotericin B (Amp B) in relatively large cumulative doses is needed to ensure appropriate control of the infection and prevention of future relapse. Patients intolerant of, or refractory to conventional Amp B have been successfully salvaged using fluconazole or lipid formulations of Amp B. A constellation of clinical, laboratory and radiologic parameters should be used to determine response and efficacy of therapy. There is sufficient evidence to support the safety and feasibility of continuing chemotherapy for acute leukemia in conjunction with antifungal treatment in patients diagnosed with CDC.


CONCLUSIONS
The development of CDC in patients with acute leukemia does not preclude further chemotherapy or constitute contraindication for bone marrow transplantation. Knowledge of the course and pattern of evolution of the disease and adopting aggressive therapeutic approach will likely reduce the morbidity and mortality from this complication.
Masood
Aisha
A
Divison of Hematology/Oncology, Louisiana State University, 1501 Kings Highway, Shreveport, LA 71119, USA. ashus3@aol.com
Sallah
Sabah
S
D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000627:therapeutic use*; D002177:Candidiasis / Q000209:etiology*; D002908:Chronic Disease; D015725:Fluconazole / Q000627:therapeutic use*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000188:drug therapy; D016879:Salvage Therapy; D013997:Time Factors
D000935:Antifungal Agents; D000666:Amphotericin B; D015725:Fluconazole