12th Congress of the European Hematology ... - Haematologica

12 th Congress of the European Hematology Association
Infection and supportive care II
0606
INVASIVE FUNGAL SINUSITIS IN PATIENTS WITH STEM CELL TRANSPLANTS AND
HEMATOLOGICAL DISEASE
C.Y. Chen, Y.C. Chen, W. Tsay, W.C. Chou, J.L. Tang, H.F. Tien
National Taiwan University Hospital, TAIPEI, Taiwan
Background. Invasive fungal sinusitis (IFS) causes high morbidity and
mortality in patients with stem cell transplants and hematological disease.
Aims. We compared IFS diagnosis using EORTC / MSG-NIAID
consensus criteria with physician-diagnosed IFS to determine the applicability
in clinical study. The clinical characteristics and prognostic factors
were correlated with invasive fungal sinusitis in patients of stem cell
transplants and hematological disease. Methods. We searched the terms
sinusitis and sinonasal infection in the discharge summary database of all
patients admitted to the Department of Internal Medicine between January
1995 and September 2006. The medical records were reviewed retrospectively.
Results. Totally, 103 hematological patients were enrolled,
including 39 with clinically diagnosed IFS and 64 with sinusitis. Forty
patients met the criteria by EORTC / MSG-NIAID consensus, including
15 with proven IFS, 16 with probable IFS, and 9 with possible IFS.
Patients with acute myeloid leukemia and absolute neutrophil count
10 days had a higher rate of IFS. Aspergillus flavus was
isolated in 12 of 20 (60%) patients, and mucormycosis was found in 4
of 20. Bony erosion and extra-sinus infiltration were found in 15 of 39
patients with clinically diagnosed IFS by CT or MRI. Refractory or
relapsed disease status was the most important prognostic factor in
hematological disease with IFS. Even with anti-fungal therapy and
aggressive surgical debridement, 21 of 39 patients (53.8%) with clinically
diagnosed IFS and 22 of 40 patients (55%) with IFS diagnosed by
EORTC / MSG-NIAID criteria died. Summary and Conclusions. IFS diagnostic
criteria by EORTC /MSG-NIAID can be applied in the clinical
research. IFS is an ominous sign in the patients with refractory / relapsed
hematological malignancy. More effective IFS treatment is needed in
patients with stem cell transplants and hematological disease, and such
treatment should be developed.
0607
SURVIVAL OF PATIENTS WITH HAEMATOLOGICAL MALIGNANCY ADMITTED TO THE
INTENSIVE CARE UNIT: PROGNOSTIC FACTORS AND OUTCOME COMPARED TO
UNSELECTED MEDICAL ICU ADMISSIONS
Q. Hill, 1 A. Hill, 1 R. Kelly, 2 C. Patalappa, 2 A.M. Whittle, 1 A.J. Scally, 3
A. Hughes, 4 A.J. Ashcroft2 1 Leeds General Infirmary, LEEDS; 2 Pinderfields Hospital, WAKEFIELD; 3 Bradford
University, BRADFORD; 4 Bradford Royal Infirmary, BRADFORD, United
Kingdom
Background. Cancer patients have historically had a very poor outcome
following ICU admission. Outcome has however improved over
the last decade. Aims. To identify factors which predict survival for critically
ill patients with haematological malignancy and which can be
readily identified prior to admission. This would improve selection of
patients suitable for ICU admission, which represents a limited resource.
We also assessed the ability of the APACHE II score to predict prognosis
in these patients. Methods. Since the ICU admission case mix will vary
between hospitals, one non-surgical admission within ± 1 week of each
haematological admission acted as a control group. Factors which might
affect outcome were assessed by multivariate regression analysis. Factors
included were age, haematological diagnosis (acute or chronic
leukemia, myeloma, lymphoma), time from haematological diagnosis to
ICU admission (0-6 months, 6-12 months, >12 months), degree of prior
treatment (admission prior to diagnosis, during first line therapy, after
first line), remission status, prior stem cell transplant, documented infection
and length of neutropenia (none, 1-10 days, >10 days). Predicted
hospital mortality was calculated from the APACHE II score by the formula
of Knaus et al (Critical Care Medicine 1985) for haematology
patients. The APACHE scores of haematology patients were compared
to controls by a two-sample t test. Predicted and actual mortalities were
compared using a one sample test of proportion. The impact of mechanical
ventilation (MV) on mortality was assessed by risk ratios. Results. We
identified 111 patients with haematological malignancy (acute leukemia
n=42, chronic leukemia n=11, myeloma n=19 and lymphoma n=39)
admitted to ICU in one teaching and three district general hospitals
(November 2000 - January 2006). Median age of haematological patients
226 | haematologica/the hematology journal | 2007; 92(s1)
was 59 years (range 17-84) and M:F ratio 1.22:1. Control patients (n=111)
were similar with median age 63 years (range 17-86) and M: F ratio
1.09:1. For control patients, overall ICU and hospital survival rates were
70% and 55% respectively while survival for haematology patients was
approximately half at 44% and 24% respectively. In multivariate regression
analysis, only increasing age (p=0.016) and documented infection
(p=0.016) predicted poor outcome. All other variables were not significant.
APACHE scores were significantly higher in haematology patients
(median 27) compared to controls (median 19) p