Asunto(s)
Inmunoglobulina M/inmunología , Gammopatía Monoclonal de Relevancia Indeterminada/terapia , Mieloma Múltiple/terapia , Enfermedades del Sistema Nervioso Periférico/terapia , Calidad de Vida , Macroglobulinemia de Waldenström/terapia , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Gammopatía Monoclonal de Relevancia Indeterminada/inmunología , Mieloma Múltiple/inmunología , Enfermedades del Sistema Nervioso Periférico/inmunología , Pronóstico , Encuestas y Cuestionarios , Macroglobulinemia de Waldenström/inmunologíaAsunto(s)
Inhibidores de las Cinasas Janus/efectos adversos , Neoplasias Primarias Secundarias/diagnóstico , Neoplasias Primarias Secundarias/etiología , Mielofibrosis Primaria/complicaciones , Pirazoles/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores , Duración de la Terapia , Femenino , Humanos , Italia/epidemiología , Inhibidores de las Cinasas Janus/uso terapéutico , Masculino , Persona de Mediana Edad , Mutación , Tasa de Mutación , Neoplasias Primarias Secundarias/epidemiología , Nitrilos , Mielofibrosis Primaria/tratamiento farmacológico , Mielofibrosis Primaria/epidemiología , Mielofibrosis Primaria/etiología , Pirazoles/uso terapéutico , Pirimidinas , Adulto JovenRESUMEN
Invasive fungal infections (IFIs) seem to be a relevant cause of morbidity and mortality in patients with chronic lymphoproliferative disorders. We studied retrospectively the epidemiology, clinical manifestations and outcome of invasive fungal infections in 42 patients with lymphoproliferative diseases, treated between January 2004 and February 2012 for probable or proven IFI. In our entire population (1355 patients) of chronic lymphoproliferative malignancies, the incidence of probable/proven IFI was 3% (molds 2.3%, yeasts 0.5%, mixed infections 0.2%). Eight patients developed a yeast infection documented by blood cultures in seven cases and by the microscopic observation of Candida spp. in the vitreum after vitrectomy in one case. Among molds we diagnosed three proven infections by histologic evidence of Aspergillus spp. (n = 2) and Mucor (n = 1) in the lung and 28 probable mycoses. Three mixed infections from both molds and yeasts were also observed. Twenty-two cases showed positivity of galactomannan antigen in the serum (n = 16), in bronchoalveolar lavage (BAL) fluid (n = 4) or in both (n = 2). Cultures were positive in 11 cases. The overall rate of response to therapy was 64%. Fungal-attributable mortality rate was 17%, with a significant difference between molds and yeasts (16% vs. 25%, p = 0.03). At univariate analysis, the only risk factors related to mortality were severe and prolonged neutropenia (p = 0.003) and age (p = 0.03). Among molds, the rapid start of antifungals was probably partially responsible, together with new drugs, for the reduction of mortality, despite the severe immunosuppression of these patients.