Successful intensive chemotherapy followed by autologous hematopoietic cell transplantation in a patient with acute myeloid leukemia and hepatosplenic candidiasis: case report and review of literature.
Hepatosplenic candidiasis (HSC) in patients with acute leukemia poses management challenges because the therapeutic limitations of the present antifungal armamentarium may adversely impact on treatment outcomes of the underlying leukemia. We report a patient with acute myeloid leukemia who developed HSC during post-remission consolidation chemotherapy and was treated with a prolonged course of caspofungin followed by fluconazole. The stabilization of infection permitted further chemotherapy and autologous hematopoietic cell transplant (HCT) without breakthrough fungemia and further dissemination of candidiasis. The favorable outcome provides further evidence that with optimal treatment, the presence of stable or non-progressive HSC is not an absolute contraindication for HCT. The use of caspofungin in the primary treatment of HSC appears to be a promising approach. The favorable outcome seen in this case is encouraging, although further study on its efficacy is warranted.
Poon
L-M
LM
Adult Stem Cell Transplant Program, Department of Hematology-Oncology, National University Hospital, Singapore, Singapore. liang_piu_koh@nuh.com.sg
Chia
H-Y
HY
Tan
L-K
LK
Liu
T-C
TC
Koh
L-P
LP
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D041022:Candida tropicalis; D002177:Candidiasis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D000077336:Caspofungin; D003561:Cytarabine / Q000009:adverse effects / Q000627:therapeutic use; D054714:Echinocandins / Q000627:therapeutic use; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D015470:Leukemia, Myeloid, Acute / Q000601:surgery*; D055666:Lipopeptides; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology; D011859:Radiography; D013158:Splenic Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology; D015898:Tomography Scanners, X-Ray Computed
D000935:Antifungal Agents; D054714:Echinocandins; D007166:Immunosuppressive Agents; D055666:Lipopeptides; D003561:Cytarabine; D015725:Fluconazole; D000077336:Caspofungin