title: Effective management of pulmonary aspergillosis invading the thoracic spine in a child with high risk ALL requiring allogeneic bone marrow transplantation.
abstract: Due to unacceptably high mortality, invasive fungal infections (IFI) have long been considered a contraindication against allogeneic stem cell transplantation. Despite severe immunosuppression an 11-year-old girl requiring allogeneic bone marrow transplant (BMT) for relapsed acute lymphoblastic leukemia was cured of a concurrent invasive pulmonary aspergillosis. Treatment comprised combinations of liposomal amphotericin B, caspofungin and voriconazole with donor granulocyte transfusions. This therapeutic regimen, including the choice of reduced intensity conditioning (RIC), allowed the patient to receive an allogeneic BMT. In hematological remission the child later developed fatal chronic graft-versus-host disease. Combined antifungal treatment and granulocyte support allow for effective management of IFI even in allogeneic stem cell transplant recipients. However, short-term benefits of RIC may be outweighed by late complications.
authors.affiliation: Division of Hematology and Oncology, Department of Pediatrics, Medical University of Graz, Austria. hansjuergen.dornbusch@meduni-graz.at
authors.forename: Hans Jürgen
authors.initials: HJ
authors.lastname: Dornbusch
authors.forename: Petra
authors.initials: P
authors.lastname: Sovinz
authors.forename: Herwig
authors.initials: H
authors.lastname: Lackner
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schwinger
authors.forename: Martin
authors.initials: M
authors.lastname: Benesch
authors.forename: Volker
authors.initials: V
authors.lastname: Strenger
authors.forename: Christian
authors.initials: C
authors.lastname: Urban
mesh_terms: D019264:Adoptive Transfer; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000628:therapy*; D016026:Bone Marrow Transplantation; D000077336:Caspofungin; D002648:Child; D054714:Echinocandins / Q000627:therapeutic use; D005260:Female; D006086:Graft vs Host Disease; D006098:Granulocytes / Q000276:immunology; D006801:Humans; D055666:Lipopeptides; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*; D011743:Pyrimidines / Q000627:therapeutic use; D013902:Radiography, Thoracic; D013131:Spine / Q000382:microbiology / Q000473:pathology; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D011743:Pyrimidines; D014230:Triazoles; C068538:liposomal amphotericin B; D000666:Amphotericin B; D000077336:Caspofungin; D065819:Voriconazole