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Invasive Fungal Sinusitis in Patients With Hematological Malignancies: A 20-Year Study From a Tertiary Academic US
Tejas S Athni1,2, Carolyn B Strauch3, Victor Kovac4
1Harvard Medical School, Boston, Massachusetts, USA.
Background:
Invasive fungal sinusitis (IFS) profoundly impacts individuals with hematological malignancies, with rapid progression and high mortality rates. In an evolving therapeutic landscape, outcomes for patients with hematological malignancies who develop IFS warrant further evaluation.
Methods:
We performed a descriptive case series and retrospective review of patients with hematologic malignancies who developed proven IFS (per European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria) between 2005 and 2024 at a tertiary academic center. Clinical data and outcomes were collected from electronic medical records. Statistical analyses included Fisher exact tests, t tests, or Wilcoxon rank-sum tests. Kaplan-Meier curves were used to estimate survival probability, and log-rank tests were compared across groups.
Results:
Thirty-one patients with confirmed IFS were identified. Most patients had acute myeloid leukemia (61.3%) and received cytotoxic chemotherapy (96.8%). Targeted oncologic therapies included BCL2 inhibitors (29.0%), FLT3 inhibitors (19.4%), antibody-based therapies (12.9%), BTK inhibitors (6.4%), and antibody-drug conjugates (6.4%). The most common fungal isolates were Aspergillus (22.6%), Fusarium (16.1%), and Rhizopus (9.7%). Amphotericin B (96.8%) and voriconazole (71.0%) were frequently used, and newer antifungals included isavuconazole (38.7%), olorofim (3.3%), and fosmanogepix (3.3%). Necrotic tissue (45.2%) and mucosal thickening (87.1%) were common on sinonasal endoscopy and computed tomography scan, respectively. Orbital (25.8%) and intracranial (9.7%) extension occurred in a minority. Most patients underwent functional endoscopic sinus surgery (80.6%). Serum fungal biomarkers were infrequently positive, with (1,3)-ß-D-glucan in 19.4% and galactomannan in 9.7%. Overall mortality was 71.0% at the end of the study period, with a median survival (interquartile range) of 101 (21-299) days. Mortality was 22.6% at 1 month, 25.8% at 2 months, 32.3% at 3 months, 41.9% at 6 months, 54.8% at 1 year, 58.1% at 2 years, and 64.5% at 3 years.
Conclusions:
Despite novel therapies and aggressive surgical interventions, patients with IFS had high mortality.
