Older patients with high‐risk fungal infections can be successfully allografted using non‐myeloablative conditioning in combination with intensified supportive care regimens

Publisher Website
Google Scholar
Abstract
Leukaemic patients with advanced disease and severe fungal infections as well as older patients with substantial co‐morbidity are usually excluded from conventional allotransplantation because of increased morbidity and mortality. We approached allogeneic transplantation in four patients with a median age of 62 years (one chronic myeloid leukaemia in blast crisis, one high‐risk acute myeloid leukaemia (AML) in first complete remission (CR1), one AML in 2nd relapse, one AML in CR2 with pre‐existing fungal lung infections (two aspergillus, two mucor) and additional co‐morbidity (diabetes n = 2, aortic aneurysm n = 1, arterial sclerosis n = 2) by combining non‐myeloablative conditioning with an intensified supportive care regimen, including amphotericin B and 4–12 (median 9) prophylactic granulocyte transfusions from granulocyte colony‐stimulating factor (G‐CSF)‐stimulated volunteer donors. G‐CSF was also given to patients until neutrophil recovery. All four patients recovered to a neutrophil count of 0·5 × 109/l after a median of 11·5 d (range 11–13 d). Prophylactic granulocyte transfusions also reduced the need for platelet transfusions and minimized mucositis. All patients were discharged at a median of 25 d (range 18–59 d) and are alive and well after a median follow‐up of > 390 d (range 336–417 d) without evidence of leukaemia. Regression of the fungal lesions was documented in three patients, with a slight progression detected by computerized tomography scan of the chest in one patient. We conclude that pulmonary fungal infections are not a contraindication for allogeneic stem cell transplantation, if non‐myeloablative conditioning regimens are used in combination with granulocyte transfusions, intravenous amphotericin B and G‐CSF.

This publication has 30 references indexed in Scilit: