Invasive mucormycosis during treatment for acute lymphoblastic leukaemia-successful management of two life-threatening diseases

Support Care Cancer. 2020 May;28(5):2157-2161. doi: 10.1007/s00520-019-04962-3. Epub 2019 Aug 14.

Abstract

A 5-year-old patient treated for acute lymphoblastic leukaemia (ALL) developed proven pulmonary invasive fungal disease (IFD) due to Actinomucor elegans. While completing ALL treatment according to AIEOP ALL protocol 2009 for further 15 months, antifungal treatment with liposomal amphotericin B and intermittent additional posaconazole was continued until immune reconstitution 7 months after the end of ALL treatment. Repeated imaging guided treatment decisions. Twenty-six and 19 months after the end of ALL treatment and antifungal treatment, respectively, the patient is still in the first complete remission and shows no signs of active invasive fungal disease (IFD).

Keywords: ALL; Antimycotic treatment; Chemotherapy; IFD; Mucormycosis.

Publication types

  • Case Reports

MeSH terms

  • Amphotericin B / therapeutic use*
  • Antifungal Agents / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Asparaginase / administration & dosage
  • Child, Preschool
  • Cyclophosphamide / administration & dosage
  • Cytarabine / administration & dosage
  • Daunorubicin / administration & dosage
  • Humans
  • Invasive Fungal Infections / drug therapy*
  • Lung Diseases, Fungal / drug therapy*
  • Lung Diseases, Fungal / microbiology
  • Male
  • Mercaptopurine / administration & dosage
  • Methotrexate / administration & dosage
  • Mucorales / isolation & purification
  • Mucormycosis / drug therapy*
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy*
  • Precursor Cell Lymphoblastic Leukemia-Lymphoma / microbiology
  • Prednisone / administration & dosage
  • Remission Induction
  • Triazoles / therapeutic use
  • Vincristine / administration & dosage

Substances

  • Antifungal Agents
  • Triazoles
  • liposomal amphotericin B
  • Cytarabine
  • Vincristine
  • posaconazole
  • Amphotericin B
  • Cyclophosphamide
  • Mercaptopurine
  • Asparaginase
  • Prednisone
  • Methotrexate
  • Daunorubicin

Supplementary concepts

  • AIEOP acute lymphoblastic leukemia protocol