Risk factors for invasive fungal infections in patients with hematologic malignancies.
| Risk Factor . | Infection . | Population . |
|---|---|---|
| Abbreviations: AML, acute myeloid leukemia; ALL, acute lymphocytic leukemia; CLL, chronic lymphocytic leukemia; allo BMT, allogeneic bone marrow transplantation; aspergillosis, invasive Aspergillus infection; candidiasis, invasive candidiasis; CVC, central venous catheter; PBSCT, peripheral blood stem cell transplantation | ||
| † Profound and persistent: < 100 cells/microliter, ≥ 10 days. | ||
| Modified with permission from Thomson Current Drugs and Tahsine Mahfouz and Elias Anaissie, Prevention of fungal infections in the immunocompromised host. Current Opinion in Investigational Drugs. 2003 ;4 (8):974 –990.12 | ||
| Prior colonization/Infection | ||
| Colonization | ||
| Gut mucosa | Invasive candidiasis | AML, autoBMT, hematological malignancies |
| Airways | Aspergillosis | Hematological malignancies |
| Skin | Fusariosis | Hematological malignancies |
| Prior infection | ||
| Aspergillosis | AML | |
| Fusariosis | AML, ALL, lymphomas | |
| Blastomycosis, Coccidioidomycosis | Lymphomas | |
| Net state of immunosuppression | ||
| Immunosuppression may be limited to one arm of the immune system (e.g., neutropenia), or broad (neutropenia, lymphopenia, asplenia and others). | ||
| Broad immunosuppression | ||
| Older age | Yeast and mould infections | Allo, autoBMT, PBSCT |
| Refractory malignancy | Yeast and mould infections | Acute leukemias |
| Myeloablative chemotherapy | Yeast and mould infections | Allo, autoBMT, PBSCT |
| Low CD 34+ dose (≤ 2 x 106/kg) | Yeast and mould infections | Allo, autoBMT, PBSCT |
| Stem cell manipulation | Various infections | Hematological malignancies |
| Histo-incompatibility | Aspergillosis | AlloBMT |
| Extensive prior chemotherapy | Hematological malignancies | |
| Neutropenia, profound, persistent † | Aspergillosis, Invasive candidiasis, Fusariosis | AML |
| Lymphopenia and CD4 cytopenia | ||
| All causes | Cryptococcosis | AlloBMT |
| Aspergillosis | Therapy with nucleoside analogs | |
| Adrenal corticosteroids | Aspergillosis, invasive candidiasis | AlloBMT, PBSCT |
| 1 to 2 mg/kg/day ≥ 3 to 5 weeks | ||
| Invasive candidiasis | Leukemias | |
| Cryptococcosis | Hematological malignancies | |
| Nucleoside analogs | Yeast and mould infections | CLL, lymphoma |
| Campath-1 H | Yeast and mould infections | CLL |
| Interleukin-2 therapy | Aspergillosis | Several patient populations |
| Infliximab (anti TNF-alpha) | Aspergillosis | AlloBMT |
| Splenectomy | Yeast and mould infections | Allo, autoBMT |
| Organ dysfunction | ||
| Pulmonary | All infections (fungal & other) | Cancer |
| Gut | Invasive candidiasis > other | Mucositis post-chemotherapy and post-radiotherapy |
| Invasive candidiasis | AlloBMT | |
| Skin | Cryptococcosis, Candidiasis | Sezary syndrome, CVC |
| Fusariosis | Hematological malignancies | |
| Aspergillosis and infection with Malassezia spp | Hematological malignancies, trauma (CVC site) | |
| Risk Factor . | Infection . | Population . |
|---|---|---|
| Abbreviations: AML, acute myeloid leukemia; ALL, acute lymphocytic leukemia; CLL, chronic lymphocytic leukemia; allo BMT, allogeneic bone marrow transplantation; aspergillosis, invasive Aspergillus infection; candidiasis, invasive candidiasis; CVC, central venous catheter; PBSCT, peripheral blood stem cell transplantation | ||
| † Profound and persistent: < 100 cells/microliter, ≥ 10 days. | ||
| Modified with permission from Thomson Current Drugs and Tahsine Mahfouz and Elias Anaissie, Prevention of fungal infections in the immunocompromised host. Current Opinion in Investigational Drugs. 2003 ;4 (8):974 –990.12 | ||
| Prior colonization/Infection | ||
| Colonization | ||
| Gut mucosa | Invasive candidiasis | AML, autoBMT, hematological malignancies |
| Airways | Aspergillosis | Hematological malignancies |
| Skin | Fusariosis | Hematological malignancies |
| Prior infection | ||
| Aspergillosis | AML | |
| Fusariosis | AML, ALL, lymphomas | |
| Blastomycosis, Coccidioidomycosis | Lymphomas | |
| Net state of immunosuppression | ||
| Immunosuppression may be limited to one arm of the immune system (e.g., neutropenia), or broad (neutropenia, lymphopenia, asplenia and others). | ||
| Broad immunosuppression | ||
| Older age | Yeast and mould infections | Allo, autoBMT, PBSCT |
| Refractory malignancy | Yeast and mould infections | Acute leukemias |
| Myeloablative chemotherapy | Yeast and mould infections | Allo, autoBMT, PBSCT |
| Low CD 34+ dose (≤ 2 x 106/kg) | Yeast and mould infections | Allo, autoBMT, PBSCT |
| Stem cell manipulation | Various infections | Hematological malignancies |
| Histo-incompatibility | Aspergillosis | AlloBMT |
| Extensive prior chemotherapy | Hematological malignancies | |
| Neutropenia, profound, persistent † | Aspergillosis, Invasive candidiasis, Fusariosis | AML |
| Lymphopenia and CD4 cytopenia | ||
| All causes | Cryptococcosis | AlloBMT |
| Aspergillosis | Therapy with nucleoside analogs | |
| Adrenal corticosteroids | Aspergillosis, invasive candidiasis | AlloBMT, PBSCT |
| 1 to 2 mg/kg/day ≥ 3 to 5 weeks | ||
| Invasive candidiasis | Leukemias | |
| Cryptococcosis | Hematological malignancies | |
| Nucleoside analogs | Yeast and mould infections | CLL, lymphoma |
| Campath-1 H | Yeast and mould infections | CLL |
| Interleukin-2 therapy | Aspergillosis | Several patient populations |
| Infliximab (anti TNF-alpha) | Aspergillosis | AlloBMT |
| Splenectomy | Yeast and mould infections | Allo, autoBMT |
| Organ dysfunction | ||
| Pulmonary | All infections (fungal & other) | Cancer |
| Gut | Invasive candidiasis > other | Mucositis post-chemotherapy and post-radiotherapy |
| Invasive candidiasis | AlloBMT | |
| Skin | Cryptococcosis, Candidiasis | Sezary syndrome, CVC |
| Fusariosis | Hematological malignancies | |
| Aspergillosis and infection with Malassezia spp | Hematological malignancies, trauma (CVC site) | |