According to a recent article published in the journal Blood, treatment with the antifungal agent Vfend™ (voriconazole) appears to provide better survival than the commonly used antifungal amphotercin B in patients whose central nervous system is infected with the fungus aspergillosis .
Patients at a high risk of central nervous system (CNS) infection include those who are undergoing stem cell transplants as part of their cancer treatment, and/or those with hematologic cancers. Hematologic cancers are cancers that originate within blood cells; they include different forms of leukemias, lymphomas, multiple myeloma, or myelodysplastic syndromes. Cancer type is determined by the kind of cell where the cancer originates and by specific characteristics of the cancer cell.
Stem cell transplant typically involves the delivery of high doses of therapy followed by an infusion of either the patient’s stem cells (autologous transplant) or a donor’s stem cells (allogeneic transplant). The stem cells are of hematopoietic origin, meaning they will mature into a type of blood cell. The purpose of stem cell infusion is to restore blood cell levels to normal after they are destroyed by high doses of therapy.
Often, patients with hematologic cancers and those who undergo a stem cell transplant for cancer other than hematologic have immune systems that are suppressed or not functioning properly. This makes the majority of these patients are susceptible to infection, which may quickly turn into a life-threatening complication. Fungal infections, such as those with aspergillosis, are common in this group of patients. If aspergillosis invades the CNS, (including the brain or spine) mortality rates, even with treatment including amphotericin B, are close to 100%. Thus, more effective therapies for this condition are needed.
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Researchers from several institutions evaluated data including 32 patients who had received a stem cell transplant; 30 had undergone an allogeneic transplant and two of had undergone an autologous transplant. Thirteen of these patients had hematologic (blood) cancer. Most patients had received prior treatment for aspergillosis with amphotercin B and were subsequently treated with Vfend.
- 54% of patients with hematologic cancers had a partial or complete disappearance of aspergillosis.
- Survival was 15% for patients with hematologic cancers.
- Survival was 22% for all patients who underwent a stem cell transplant.
- Patients who underwent surgery on their brain to treat fungus (removal of sites of infection, implantation of drains, etc.) had improved survival compared with Vfend alone.
The researchers concluded that treatment with Vfend, particularly in addition to surgery of the brain, appears to have improved survival amphotercin B for the treatment of aspergillosis that has invaded the CNS in patients with hematologic cancers or those who have undergone stem cell transplants. Patients or caregivers of patients who have aspergilliosis that has invaded the CNS may wish to speak with their physician regarding their individual risks and benefits of treatment with Vfend and surgery.
Reference: Schwartz S, Ruhnke M, Ribaud P, et al. Improved outcome in central nervous system aspergillosis, using voriconazole treatment. Blood. 2005; 106: 2641-2645.
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