title: Successful management of chronic disseminated candidiasis in hematologic patients treated with high-dose liposomal amphotericin B: a retrospective study of the SEIFEM registry.
abstract: Chronic disseminated candidiasis (CDC) is a complication of Candida infection in immunocompromised patients, involving the liver and spleen, and rarely other organs. The aim of the study is to identify the best antifungal drug for hematologic immunocompromised patients with CDC.
  
  
  
  In this multicentric retrospective study, the charts of 20 patients with CDC following cytotoxic agent protocols for hematological malignancies, diagnosed from 2003 to 2013, were analyzed. The response to systemic antifungal therapy within 90 days from CDC diagnosis and the possible delay in chemotherapy plan, due to the infection, were evaluated.
  
  
  
  Six patients were treated with high-dose (HD; 5 mg/kg/daily) liposomal amphotericin B (L-AmB), whereas three received standard-dose (SD) L-AmB (3 mg/kg/daily). Azoles were given to six patients; the remaining five were treated with echinocandins. All patients treated with HD L-AmB (6/6-100 %) achieved complete resolution of CDC; one of them had to interrupt the chemotherapy program for the infection. In the SD L-AmB group, treatment failed in the 100 % of cases and one patient had to delay chemotherapy for the infection. Of the six patients who received azoles, two achieved complete resolution of the infection, four experienced treatment failure, and only three performed chemotherapy as planned. Echinocandins treatment resulted in complete resolution of the infection in 2/5 cases, partial response in 2/5 cases, and failure in one case. In this group, 3/5 patients completed chemotherapy as planned.
  
  
  
  This study shows that HD L-AmB was particularly effective against CDC in hematologic patients, allowing most patients to continue cytotoxic agent program.
authors.affiliation: Department of Clinical Medicine and Surgery, Hematology, Federico II University, via Sergio Pansini, 5, Naples, 80131, Italy. roberta.dellapepa@unina.it.
authors.forename: Roberta
authors.initials: R
authors.lastname: Della Pepa
authors.affiliation: Department of Clinical Medicine and Surgery, Hematology, Federico II University, via Sergio Pansini, 5, Naples, 80131, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Picardi
authors.affiliation: Hematology Catholic University Sacro Cuore, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Sorà
authors.affiliation: Hematology Catholic University Sacro Cuore, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Stamouli
authors.affiliation: Hematology Le Molinette Hospital, Torino, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Busca
authors.affiliation: Hematology University of Udine, Udine, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Candoni
authors.affiliation: Hematology University of Bari, Bari, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Delia
authors.affiliation: Hematology University of Firenze, Florence, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Fanci
authors.affiliation: Hematology University of Perugia, Perugia, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Perriello
authors.affiliation: Hematology Niguarda Hospital, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Zancanella
authors.affiliation: Hematology Niguarda Hospital, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Nosari
authors.affiliation: Hematology Pescara Hospital, Pescara, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Salutari
authors.affiliation: Haematology, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Marchesi
authors.affiliation: Department of Clinical Medicine and Surgery, Hematology, Federico II University, via Sergio Pansini, 5, Naples, 80131, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Pane
authors.affiliation: Hematology Catholic University Sacro Cuore, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Pagano
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B
keywords: Chronic disseminated candidiasis; Leukemia; Liposomal amphotericin B