Hepatosplenic candidiasis--a contraindication to marrow transplantation?

Abstract:

:To determine whether a prior history of hepatosplenic candidiasis resulted in increased Candida-associated morbidity and mortality after marrow transplant, 15 consecutive patients with biopsy-proven hepatosplenic candidiasis were observed prospectively. All patients received amphotericin B before transplant. Amphotericin B was continued at a dose of 0.5 mg/kg/day from conditioning through marrow engraftment, at which time it was discontinued if computerized tomography (CT) evidence of disease was stable or improved. Patients were observed for progression of candidiasis for the first 100 days after transplant. The amount and duration of antifungal therapy received before transplant varied widely. The majority of patients (73%) had persistently abnormal CT scans before transplant. After transplant, 3 of 15 died (20%) with evidence of fungal disease, although fungal species differed from those diagnosed pretransplant, compared with a historical mortality rate of 90% in posttransplant patients with documented hepatosplenic candida. Comparison CT scans obtained before and after transplant showed improvement in 9 of 15 (60%), complete resolution in 2 of 15 (13%), and none showed progression. We conclude that hepatosplenic candidiasis is not an absolute contraindication to marrow transplant when patients receive amphotericin B therapy before transplant and continue therapy until engraftment is established.

journal_name

Blood

journal_title

Blood

authors

Bjerke JW,Meyers JD,Bowden RA

subject

Has Abstract

pub_date

1994-10-15 00:00:00

pages

2811-4

issue

8

eissn

0006-4971

issn

1528-0020

journal_volume

84

pub_type

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