title: Breakthrough zygomycosis after voriconazole administration among patients with hematologic malignancies who receive hematopoietic stem-cell transplants or intensive chemotherapy.
abstract: Zygomycosis is increasingly reported as a cause of life-threatening fungal infections. A higher proportion of cases reported over the last decades have been in cancer patients, with or without hematopoietic stem cell transplantation (HSCT). The new anti-fungal agent voriconazole is a recently identified risk factor for developing zygomycosis. We reviewed the clinical characteristics and outcomes of a large cohort of cancer patients who developed zygomycosis after exposure to voriconazole. Health care professionals at 13 large cancer centers provided clinical information on cancer patients with zygomycosis and prior exposure to voriconazole. Criteria for inclusion were 5 days or more of voriconazole use and diagnostic confirmation with tissue or histology. Fifty-eight cases were identified among patients with hematologic malignancies, 62% including patients who underwent a HSCT procedure. Fifty-six patients received voriconazole for primary or secondary prophylaxis against fungal infection. In addition to prior exposure to voriconazole, patients also had several of the previously established risk factors for zygomycosis. Amphotericin B was the most commonly prescribed anti-fungal therapy. Overall mortality was 73%. We conclude that zygomycosis after exposure to voriconazole is a recently described entity that is frequently fatal, despite treatment with currently available anti-fungal agents and surgery.
authors.affiliation: Department of Pharmacy, Division of Hematology/Oncology, Northwestern Memorial Hospital, Chicago, IL, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Trifilio
authors.forename: C L
authors.initials: CL
authors.lastname: Bennett
authors.forename: P R
authors.initials: PR
authors.lastname: Yarnold
authors.forename: J M
authors.initials: JM
authors.lastname: McKoy
authors.forename: J
authors.initials: J
authors.lastname: Parada
authors.forename: J
authors.initials: J
authors.lastname: Mehta
authors.forename: G
authors.initials: G
authors.lastname: Chamilos
authors.forename: F
authors.initials: F
authors.lastname: Palella
authors.forename: L
authors.initials: L
authors.lastname: Kennedy
authors.forename: K
authors.initials: K
authors.lastname: Mullane
authors.forename: M S
authors.initials: MS
authors.lastname: Tallman
authors.forename: A
authors.initials: A
authors.lastname: Evens
authors.forename: M H
authors.initials: MH
authors.lastname: Scheetz
authors.forename: W
authors.initials: W
authors.lastname: Blum
authors.forename: D P
authors.initials: DP
authors.lastname: Kontoyiannis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D019337:Hematologic Neoplasms / Q000188:drug therapy* / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011743:Pyrimidines / Q000008:administration & dosage*; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage*; D065819:Voriconazole; D020096:Zygomycosis / Q000453:epidemiology* / Q000209:etiology*
chemical_list: D011743:Pyrimidines; D014230:Triazoles; D000666:Amphotericin B; D065819:Voriconazole