CRYPTOCOCCOSIS IN HODGKINS-DISEASE - DESCRIPTION OF 2 CASES AND REVIEW OF THE LITERATURE

Citation
A. Korfel et al., CRYPTOCOCCOSIS IN HODGKINS-DISEASE - DESCRIPTION OF 2 CASES AND REVIEW OF THE LITERATURE, Annals of hematology, 76(6), 1998, pp. 283-286
Citations number
15
Categorie Soggetti
Hematology
Journal title
ISSN journal
09395555
Volume
76
Issue
6
Year of publication
1998
Pages
283 - 286
Database
ISI
SICI code
0939-5555(1998)76:6<283:CIH-DO>2.0.ZU;2-D
Abstract
Systemic mycosis caused by Cryptococcus neoformans frequently becomes life threatening in patients with cellular immunodeficiencies. In cont rast to AIDS patients, there are only a few reports of concurrent syst emic cryptococcosis in patients with Hodgkin's disease (HD). Only two of 75 (2.7%) patients with HD who were consecutively admitted to our h ospital in the past decade developed Cryptococcus neoformans mans infe ction. Both had stage IVB (Ann Arbor) HD with bone marrow involvement and absolute lymphopenia (<1/nl). We have reviewed the literature and analyzed the data of 54 cases with concurrent cryptococcosis and HD. P resence of HD for greater than or equal to 12 months, stage IV disease , absolute lymphopenia (<1/nl), and extensive pretreatment were the mo st common features among these patients and must be regarded as predis posing for acquiring a cryptococcal infection. In our patients antimyc otic therapy was successful using liposomal amphotericin B (lipAmB) si multaneously with cytotoxic therapy for HD. Drug level measurements pe rformed in one patient revealed a higher level of amphotericin B in CS F when the liposomal formulation was administered as compared with the level in CSF after administration of conventional amphotericin B. To our knowledge, this is the first report on antimycotic treatment of cr yptococcosis with lipAmB in patients with HD. Regarding the favorable therapeutic index of lipAmB as compared with conventional amphotericin B, the drug should be considered as a less toxic and perhaps more eff ective alternative in the therapy of acute cryptococcosis, especially when cytotoxic treatment is administered simultaneously.