SUCCESSFUL TREATMENT OF HEPATOSPLENIC CANDIDIASIS THROUGH REPEATED CYCLES OF CHEMOTHERAPY AND NEUTROPENIA

Background. Hepatosplenic candidiasis (HSC) or chronic disseminated ca ndidiasis is an increasingly recognized problem in patients with cance r. Whether patients with HSC should continue to receive antineoplastic therapy, which may cause neutropenia with the risk for progressive HS C or breakthrough fungemia, can be a major dilemma. Patients with HSC at the National Cancer Institute continue antineoplastic therapy, when possible, during antifungal therapy for HSC, despite repeated bouts o f neutropenia. Therefore, whether this strategy resulted in breakthrou gh fungemia or progression of HSC was investigated. Methods. All patie nts consecutively treated at the National Cancer Institute at the Warr en-Grant Magnuson Clinical Center from 1982-1992 for HSC were prospect ively studied for therapeutic and outcome variables of antifungal and antineoplastic management. Each case was summarized on a time-event li ne to quantify the duration of simultaneous periods of antineoplastic therapy and antifungal therapy (AFT). Results. Sixteen patients (media n age, 22 years) with HSC were studied. Eleven patients had relapsed t umor and 5 had newly diagnosed tumor. During antifungal therapy for HS C, 12 of 16 patients were neutropenic for a median of 10 days (range, 6-91 days) and 11 were profoundly neutropenic for a median of 13 days (range, 1-55 days). Hepatosplenic candidiasis was successfully treated with complete antifungal response in 12 patients and a partial respon se in 2; 2 patients continued to receive AFT. No patient had breakthro ugh fungemia and two patients had progression of HSC, only one episode of which occurred during neutropenia. Conclusions. Hepatosplenic cand idiasis in patients with cancer may be treated successfully under care ful observation through repeated courses of chemotherapy-induced neutr openia without progression of hepatosplenic candidiasis or breakthroug h fungemia.