Mucormycosis in hematopoetic stem cell transplant recipients: A systematic review.

Abstract

e19043 Background: Mucormycosis is a life-threatening infection caused by opportunistic fungi belonging to the order Mucorales. High mortality is reported in hematopoietic stem cell transplant (HSCT) recipients who develop mucormycosis in the post-transplant immunosuppressed state. This study reviews the epidemiology, diagnosis, treatment and outcome of mucormycosis in HSCT recipients. Methods: A systematic literature search was conducted on PubMed and Embase from inception to 5 Jan, 2022 using MeSH terms for 'mucormycosis' and 'hematopoietic stem cell transplantation'. We included case reports, case series and observational studies reporting individual patient data. Summary statistics were calculated for patient characteristics by tabulation and percentages. Hazard ratios were calculated using unconditional Cox proportional hazard models. Data analysis was done using SPSS. Results: The initial search revealed 405 articles. After exclusion of duplicates, reviews and non-relevant articles, data was included from 122 articles (183 patients). The most common sites of infection were lung (36.6%) and rhinocerebrum (7.1%). Disseminated infection occurred in 34 (18.6%) cases. Diagnosis was confirmed using histology, culture or both in 27%, 13% and 34% of cases, respectively. Seven genera of zygomycetes were identified, of which Rhizopus was most common (37.2%). The most common antifungals used were liposomal amphotericin B (LAMB) (74%) and posaconazole (27%). Surgical debridement was employed in 64 (35%) cases. Overall survival was 32% with LAMB and 34% with surgical debridement. Sixteen patients did not receive any therapy; none survived. Mortality was reported in 121 patients (68.4%). Death was attributed to mucormycosis in 84 cases (45.9%). Death attributed to mucormycosis was more frequent in Rhizopus infections (56%) compared to other species (40%, HR = 1.89, 95% CI 1.13-3.15, p < 0.05). Patients who underwent HSCT due to chronic myeloid leukemia (CML) had greater mortality due to mucormycosis (72%) compared to those with other underlying diseases (43%, HR = 2.31, 95% CI 1.26-4.21, p < 0.05). Conclusions: Mucormycosis has high mortality in HSCT recipients. Surgery and LAMB therapy can significantly improve survival. Prospective studies need to be undertaken to identify risk factors for mortality and appropriate treatment strategies. [Table: see text]