02). Comparison of Kaplan–Meier

curves of PM patients with risk scores of >22 (n = 27) vs. ≤22 (n = 48) confirmed a significantly higher rate of mortality within 28 days of initial PM presentation (HR 8.2, 3.6–18.9, P < 0.0001) and higher cumulative 28-day mortality (14.6% vs. 78%, P < 0.001). The estimated median survival time in PM patients with a risk score >22 was 7 days. selleck chemicals llc The majority of patients [47 (73%)] received Mucorales-active antifungal therapy, either amphotericin B formulation [54 (72%)] (as monotherapy or in combination with other antifungal regimens) or posaconazole [10 (13%)] (as monotherapy or in combination with other antifungal regimens) within 5 days after symptoms initiation. Administration of appropriate therapy (over 5 days) was delayed in 28 patients (37%). Immune augmentation therapy included white blood cell (WBC) transfusions, and administration of haematopoietic growth factors (granulocyte-macrophage colony-stimulating factor/granulocyte colony-stimulating factor) or interferon-γ. Thirty-one per cent of the patients received a colony-stimulating factor during treatment, 8% WBC transfusions and 7% interferon-γ. Surgical management, including debridement and wedge resection, was performed in 28 patients (37%). Overall, 28 of 75 patients (37%) died

within 4-week follow-up [median time of death, 34 days after diagnosis (range, 0–94 days)]. No treatment variables were found to be independently associated with improved survival when patients selleckchem were stratified by the mortality risk score. Mucormycosis has emerged as the second most common invasive mould infection after aspergillosis in patients with haematological malignancies and allogeneic HSCT.[2] In this 12-year retrospective study, we identified 75 such patients with PM. The most important conditions predisposing to mucormycosis,

Phenylethanolamine N-methyltransferase according to various studies, include malignant haematological diseases with or without HSCT, prolonged and severe neutropenia, poorly controlled diabetes mellitus with or without diabetic ketoacidosis, iron overload, major trauma, prolonged use of corticosteroids, illicit intravenous drug use, neonatal prematurity and malnourishment.[3, 11, 12] Not surprisingly, 57% and 64% of our patients, respectively, were profoundly neutropenic and lymphocytopenic. Prior corticosteroid therapy (55%) and diabetes mellitus (31%) appeared to be common additional risk factors for PM. Moreover, 57% of the patients had refractory haematological disease and thus received intensive cytotoxic chemotherapy. Also, 48% of the patients underwent HSCT, 81% of whom were allogeneic transplant recipients. We stratified our patient population according to the probability of death using easily available clinical, laboratory and radiological variables at the time of diagnosis.