FUSARIUM, A SIGNIFICANT EMERGING PATHOGEN IN PATIENTS WITH HEMATOLOGIC MALIGNANCY - 10 YEARS EXPERIENCE AT A CANCER CENTER AND IMPLICATIONSFOR MANAGEMENT

Despite increasing reports of life-threatening Fusarium infections, li ttle is known about its pathogenesis and management. To evaluate the e pidemiology, clinicopathologic features, and outcome of invasive fusar iosis in patients with hematologic cancer, we conducted a retrospectiv e study of invasive fusarial infections in patients with hematologic m alignancy treated at a referral cancer center over a 10-year period (1 986 to 1995), as well as a literature review, Forty patients with diss eminated and three patients with invasive lung infection were included in the analysis. All patients were immunocompromised. The infection o ccurred in three patients postengraftment following bone marrow transp lantation. All patients were diagnosed antemortem, Thirteen patients r esponded to therapy, but the infection relapsed in two of them. Respon se was associated with granulocyte transfusions, amphotericin B lipid formulations (four patients each), and an investigational triazole (tw o patients), Resolution of infection was only seen in patients who ult imately recovered from myelosuppression. Portal of entry was the skin (33%), the sinopulmonary tree (30%), and unknown (37%). Fusarium cause s serious morbidity and mortality, and may mimic aspergillosis. The in fection seems to respond to newer therapeutic approaches, but only in patients with ultimate recovery from myelosuppression, and it may rela pse if neutropenia recurs. (C) 1997 by The American Society of Hematol ogy.