International Retrospective Analysis of 73 Cases of Invasive Fusariosis Treated with Voriconazole

Abstract

ABSTRACT The outcomes for 73 invasive fusariosis patients treated with voriconazole were investigated. Patients with proven ( n = 67) or probable ( n = 6) infections were identified from the voriconazole clinical database ( n = 39) and the French National Reference Center for Mycoses and Antifungals database ( n = 34). Investigator-determined success was a complete or partial response. Survival was determined from day 1 of voriconazole therapy to the last day known alive. Patients were 2 to 79 years old (median, 43 years), and 66% were male. Identified Fusarium species (62%) were F. solani , F. moniliforme , F. proliferatum , and F. oxysporum . Underlying conditions analyzed included hematopoietic stem cell transplant (HSCT; 18%), hematologic malignancy (HM; 60%), chronic immunosuppression (CI; 12%), or other condition (OC; 10%). Infection sites were brain (5%), disseminated excluding brain (67%), lungs/sinus (15%), and other (12%). Most patients (64%) were or had recently been neutropenic (<500 cells/mm 3 ). Therapy duration was 1 to 480 days (median, 57 days), with a 47% success rate. Baseline neutropenia impacted success adversely ( P ≤ 0.03). Success varied by underlying condition (HSCT, 38%; HM, 45%; CI, 44%; OC, 71%) and infection site (brain, 0%; disseminated, 45%; other, 56%; lung/sinus, 64%) ( P > 0.05). Combination therapy (13 patients) was no better than treatment with voriconazole alone. Overall, 59% of the patients died (49% died of fusariosis), and 90-day survival was 42%. Site of infection influenced survival ( P = 0.02). Median survival (in days) by species was as follows: F. solani , 213; F. oxysporum , 112; Fusarium spp., 101; F. proliferatum , 84; F. moniliforme , 76. We conclude that voriconazole is a therapeutic option for invasive fusariosis.