[1, 2] Crude mortality rate for PM typically exceeds 80%,[2] although early treatment with lipid amphotericin B formulations and possibly posaconazole significantly improves outcome.[4-7] Although risk factors for development of PM are well known,[2] no studies have examined prognostic indicators (assessed at the time of diagnosis) that could help clinicians stratify patients who are at risk for rapid disease progression and early death.[8] To that end, we retrospectively reviewed all cases of PM from 2000 to 2012 in our institution to examine whether baseline clinical or laboratory risk factors at the time of the diagnosis of PM could serve

as prognostic markers for stratifying patients at low vs. high risk for early death (within 4 weeks). We analysed all haematological malignancy patients diagnosed with PM at MD Anderson Cancer Center, Houston, Texas, during a 12-year period from January 1, 2001 to January 1, 2012. Only LY2109761 supplier patients who met the criteria for proven or probable PM according to the revised definitions of the European Organization for Research and Treatment of Cancer and Mycoses

Study Group were included in the study.[9] Mould isolates were identified according to standard morphological criteria.[10] selleck products Patient electronic records were reviewed for demographic characteristics, type and status of underlying malignancy, history of HSCT, risk factors for invasive mould infection present

at diagnosis [e.g. neutropenia, lymphocytopenia, monocytopenia, receipt of adrenal corticosteroids or anti-T-cell antibodies, graft-versus-host disease (GvHD)], metabolic abnormalities (e.g. diabetes, hyperglycaemia, acidosis, malnutrition, iron overload), severity of presenting disease based on chest/sinus computed tomography and initial treatment strategies employed during the first 28 days following the diagnosis of PM. We excluded patients with mixed fungal pulmonary almost infections. Neutropenia was defined as a neutrophil count less than 500 mm−3, whereas monocytopenia was defined as a monocyte count less than 10 cells mm−3. Lymphopenia and severe lymphopenia were classified as an absolute lymphocyte count (ALC) less than 500 and 100 cells mm−3 respectively. Malnutrition was defined as a serum albumin level less than 3.5 g dl−1. PM was considered a breakthrough infection rather than a ‘de novo’ if the infection developed more than 7 days after initiation of preventive or empiric antifungal therapy. Delayed Mucorales-active therapy was defined as the initiation of effective treatment more than 5 days after primary symptoms based on previous studies.[7] The primary endpoint was mortality at 4 weeks after PM diagnosis. Death was attributed to PM if the patient had clinical, microbiological, histological and/or radiological evidence of active fungal infection at the time of death.