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Predictors of Early and Late Mortality for Patients with Hematologic Malignancy and Invasive Mold Disease
Eva L Yashphe1, Ron Ram2,3, Irit Avivi2,3
1Internal Medicine T, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel.
Background:
Invasive mold infections (IMI) are leading infectious causes of mortality among patients with hematological malignancies.
Objectives:
To determine the relative contribution of host, disease, and treatment-related factors to patient survival.
Methods:
An observational, retrospective cohort study reviewing the medical records of patients with hematological malignancy and IMI (2006-2016). Causes of death were classified up to 90 days after diagnosis. Kaplan-Meier and Cox regression analyses were used to determine risk factors for early, late, and overall mortality.
Results:
Eighty-six patients with IMI were included; 29 (34%) and 41 (47%) died within 6 and 12 weeks of diagnosis, respectively. Death was attributed to IMI in 22 (53.6%) patients, all of whom died within 45 days of diagnosis. Risk factors for early mortality were elevated serum galactomannan, treatment with amphotericin B, IMI progression 3 weeks after diagnosis, and lymphoma undergoing HCT. Late mortality was associated with relapsed/refractory malignancy and elevated serum galactomannan.
Conclusions:
In this single-center study of patients with IMI, infections were the most frequent causes of death, and time-dependent risk factors for death were identified. These results may help direct risk-assessment and monitoring of patients undergoing treatment of IMI.
Insights
Invasive mold infections (IMI) are a major cause of death in hematological malignancy patients. Identifying early and late mortality risk factors like elevated galactomannan aids patient monitoring and treatment.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Invasive mold infections (IMI) are a primary cause of death in patients with hematological malignancies.
- Understanding mortality factors is crucial for improving outcomes in this vulnerable population.
Purpose of the Study:
- To identify host, disease, and treatment-related factors influencing patient survival.
- To analyze the relative contribution of these factors to mortality in hematological malignancy patients with IMI.
Main Methods:
- Retrospective cohort study of 86 patients with hematological malignancy and IMI (2006-2016).
- Kaplan-Meier and Cox regression analyses were employed to determine mortality risk factors.
- Causes of death were classified within 90 days of diagnosis.
Main Results:
- 34% and 47% of patients died within 6 and 12 weeks, respectively.
- IMI was the cause of death in 53.6% of cases, all within 45 days.
- Early mortality risk factors included elevated serum galactomannan, amphotericin B treatment, IMI progression, and lymphoma with HCT. Late mortality was linked to relapsed/refractory malignancy and elevated galactomannan.
Conclusions:
- Infections are the leading cause of death in this patient cohort.
- Time-dependent risk factors for mortality were identified, aiding risk assessment.
- Findings support targeted monitoring and risk stratification for patients with IMI.
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