Indications and outcomes of antifungal therapy in French patients with haematological conditions or recipients of haematopoietic stem cell transplantation

Invasive fungal disease (IFD) remains a major concern in patients with haematological conditions. We describe diagnoses, therapeutic management and outcomes in unselected consecutive patients from haematological facilities treated for suspected or documented IFD. In this observational prospective study, children/adults with haematological conditions or haematopoietic stem cell transplantation (HSCT) were recruited upon start of non-prophylactic systemic antifungal treatment in 37 French haematological facilities (December 2007 to December 2008). IFD episodes were classified according to the 2008 EORTC/MSG criteria. The cohort included 419 patients (298 adults and 121 children): 88 haematological malignancies, 28 HSCT recipients and 68 neutropenic. Patients had 423 IFD episodes: 21 mycologically documented (59 probable/proven aspergillosis, 32 proven candidiasis and 9 probable/proven other IFD) and 20 classified as possible IFD. The remaining cases were assigned to two groups: febrile neutropenia (34) and unclassified (25), 9 of which were classified as possible/probable/proven IFD by day 7. Treatment was thus initiated early in 59 of patients; liposomal amphotericin B and caspofungin were the most common single-agent therapies. The 12 week mortality was 18 for probable/proven aspergillosis, 15 for proven candidiasis, 10 for probable/proven other IFD, 9 for possible IFD, 3 for febrile neutropenia and 12 for unclassified episodes (log rank P0.016); it was dependent on age, complete remission of underlying haematological disease and mechanical ventilation. In this comprehensive sample of haematological patients receiving antifungal treatment, we observe a widespread resort to early therapy and a low mortality rate, including in patients with probable or proven IFD.