PURPOSE: To determine survival in immunocompromised patients after surgical treatment of pulmonary Invasive Fungal (mold) Infection (IFI).
METHODS: Single-center, retrospective chart review of lung resection or biopsy in 54 immunocompromised patients age 5-64 years (37.3 mean), between 12/1986-2/2007. Setting: An NCI and NCCN comprehensive cancer center.
RESULTS: The intent of surgery was to establish a definitive diagnosis, to facilitate therapy; and attempt debulking of fungal organism in necrotic foci. Criteria for surgical treatment were localized resectable infection with predicted acceptable morbidity and mortality. The interventions were: Open lung biopsies 2(4%), Segmentectomies 2(4%), Wedge Resections 38(70%), Lobectomies 13(24%) and other 2(4%); 14(26%) patients had 2 or more locations of lung resection. 5(9%) patients died within 30 days after surgery.63% of patients had prolonged neutropenia (WBC<1000). Most common pathogens were Aspergillus species 38(70%) and Scedosporium (Monosporium) Apiospermum 3(6%). 40 patients had hematopoietic cell transplantation (HCT) before and/or after surgery; 34 had allogenic HCT. 16 patients remain alive and 17(31%) among deceased had IFI recurrence. The estimated survival curve based on Kaplan-Meier estimator indicates that survival rates were 46%(SE=0.069) - one year, 36%(SE=0.0688) - two years, 28%(SE=0.0654) - three years and 22%(SE= 0.0655) - four years (confidence limits are reflected in chart). Main causes of death were recurrent cancer, graft vs. host disease, recurrent fungal disease, other co-morbid diseases and post-surgical complications.
CONCLUSION: IFI is a common life-threatening problem in immunocompromised patients with hematological malignancies and a particular risk during HCT. Patients with lung resection before HCT had overall longer survival than those, resected after HCT.
CLINICAL IMPLICATIONS: Patients should be carefully assessed for the presence of invasive fungal disease before HCT and if possible, areas of invasive infection resected, with subsequent anti-fungal therapy guided by the results of microbiologic investigation.
DISCLOSURE: Marine Khojabekyan, No Financial Disclosure Information; No Product/Research Disclosure Information