Philip W Wong, MD(*); M Zakowski, MD and D A White, MD. Memorial Sloan-Kettering Cancer Center, New York, NY.
PURPOSE: Cryptococcal infection can cause morbidity and mortality in ICH. Amphotericin B with or without flucytosine is the treatment of choice for patients (pts) with systemic cryptococcosis. Triazole therapy (tx) particularly fluconazole (F) is also an effective drug in less severely ill pts and may be effective in PC. It is less toxic and available in oral form. Current data on tx are mainly in the HIV population. The usefulness of triazole tx in PC in non-HIV ICH is not described.
METHODS: We reviewed our experience at MSKCC from 1/1/96-12/31/99 on the clinical course and outcome of pts with hematologic malignancy HIV negative and PC.
RESULTS: Six pts were found. Their clinical characteristics and tx are shown below. 5/6 pts were asymptomatic, and one with allogeneic BMT presented with cough and fever.
4/6 had lymphopenia. 5/6 of pts had either chemotx, radiotx or steroids prior to diagnosis (dx). Dx were by open lung biopsy (4), bronchoscopy (1) and needle aspiration (1). All pts survived the infection.
(*) sCA, serum cryptococcal antigen; CSF+, cerebrospinal fluid study;
([double dagger]) follow-up time in months (m); F, fluconazole; I, itraconazole
CONCLUSION: Triazole antifungal therapy alone was successful in the treatment of our series of pts with HM and PC. The cryptococcal antigen was elevated in only one case and no patient had evidence for central nervous system involvement. Optimum length of therapy is not known.
CLINICAL IMPLICATIONS: Triazole antifungal agents hold great promise for treatment of PC in non-HIV ICH in selected cases.
COPYRIGHT 2000 American College of Chest Physicians
COPYRIGHT 2001 Gale Group
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