Clinical Features and Treatment Progress of Invasive Mucormycosis in Patients with Hematological Malignancies

Abstract

The incidence rate of invasive mucormycosis (IM) in patients with hematological malignancies (HMs) is increasing year by year, ranging from 0.07% to 4.29%, and the mortality rate is mostly higher than 50%. With the ongoing pandemic of COVID-19, COVID-19-associated mucormycosis (CAM) also became a global health threat. Patients with high risk factors such as active HMs, relapsed/refractory leukemia, prolonged neutropenia may still develop breakthrough mucormycosis (BT-MCR) even under the prophylaxis of Mucorales-active antifungals, and such patients often have higher mortality. Rhizopus spp. is the most common genus associated with IM, followed by Mucor spp. and Lichtheimia spp. Pulmonary mucormycosis (PM) is the most common form of IM in patients with HMs, followed by rhino-orbital-cerebral mucormycosis (ROCM) and disseminated mucormycosis. The prognosis of IM patients with neutrophil recovery, localized IM and receiving early combined medical–surgical therapy is usually better. As for management of the disease, risk factors should be eliminated firstly. Liposome amphotericin B (L-AmB) combined with surgery is the initial treatment scheme of IM. Those who are intolerant to L-AmB can choose intravenous formulations or tablets of isavuconazole or posaconazole. Patients who are refractory to monotherapy can turn to combined antifungals therapy.

Development of a monoclonal antibody and a lateral-flow device for the rapid detection of a Mucorales-specific biomarker

“…All Mucorales fungi were detected, including the most common causes of mucoromycosis worldwide, namely Lichtheimia spp., Mucor circinelloides, Rhizopus arrhizus, and Rhizopus microsporus var. rhizopodiformis (Roden et al, 2005;Gomes et al, 2011;Skiada et al, 2011;Laternier et al, 2012;Zaki et al, 2014;Prakash and Chakrabarti, 2019;Skiada et al, 2020;Radotra and Challa, 2022;Özbek et al, 2023;Pham et al, 2023;Yang et al, 2023), and also rarer, emerging, or more regionally-prevalent causes of the disease (Gomes et al, 2011;Skiada et al, 2020) including Actinomucor (Tully et al, 2009), Apophysomyces (Chander et al, 2015), Cunninghamella (Mita et al, 2022), other Mucor spp. (Deja et al, 2006;A ́lvarez et al, 2011;Lu et al, 2013;Chander et al, 2018), Rhizomucor (Chander et al, 2018;Schober et al, 2021), other Rhizopus spp.…”

Overcoming the Odds: Successful Treatment of Disseminated Mucormycosis with Gastrointestinal and Jaw Involvement in a Patient with Acute Myeloid Leukemia

“…Allogeneic stem cell transplant recipients have the highest incidence rate for mucormycosis with an estimated incidence rate of 1.19% followed by acute lymphoblastic leukemia at 0.75%, while patients with acute myeloid leukemia had an estimated incidence rate of 0.45% [ 6 ].…”

“…Severe graft versus host disease, high-dose corticosteroids, previous CMV infection, and increasing age are the main risk factors [ 6 , 7 ] Rhino-orbital-cerebral mucormycosis is the most common form of the disease, however, in patients with hematological malignancies and allogeneic stem cell transplant recipients, pulmonary mucormycosis is most common form followed by rhino-orbital-cerebral mucormycosis (ROCM) and disseminated mucormycosis [ 2 , 4 , 6 , 8 , 9 ].…”