In the past decade, there has been significant progress in clinical hematology with the discovery of targeted molecules and thus the achievement of both hematologic and molecular responses. Nevertheless, chemotherapy remains the treatment of choice for many types of hematological malignancies. Aggressive chemotherapy leads to immunosuppression, accompanied by a high rate of infections and an increased rate of treatment-related mortality. Invasive fungal infections as well as more common bacterial and viral infections are frequent in immunocompromised patients as they are difficult to diagnose and treat. Pleuropulmonary infections in immunocompromised patients are diagnosed using clinical examination, imaging and laboratory tests. Many laboratory tests are run for several days before a final result is given and are expensive. Computer tomography is a reliable technique, but it is encumbered by high irradiation and high cost, and can assess lesions larger than 1 cm. Transthoracic ultrasound is a modern method, used in the diagnostic algorithm of pleuropulmonary pathology. It allows the diagnosis of small lesions, can be performed at the patients’ bedside, with acceptable costs and no irradiation. A fast, informed and accurate medical decision is essential for a favorable outcome in immunosuppressed patients with an adjacent infection. In the current case series we present the implementation of a new protocol for the follow-up of immunocompromised patients using transthoracic ultrasonography, of great potential use in the clinic.
If the inline PDF is not rendering correctly, you can download the PDF file here.
1. TANASE A. TOMULEASA C. MARCULESCU A. BARDAS A. COLITA A ORBAN C. et al. Haploidentical donors: can faster transplantation be life-saving for patients with advanceddisease? Acta Haematol. 2016; 135(4):211-6.
2. BRAMMER J.E. KHOURI I. GABALLA S. ANDERLINI P. TOMULEASA C. AHMED S. et al. Outcomes of haploidentical stem cell transplantation for lymphoma with melphalan-based conditioning. Biol Blood Marrow Transplant. 2016; 22(3):493-8.
3. PAGANO L. CAIRA M. CANDONI A. OFFIDANI M. FIANCHI L. MARTINO B. et al. The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica 2006; 91:1068.
4. CHAMILOS G. LUNA M. LEWIS R.E. BODEY G.P. CHEMALY R. TARRAND J.J. et al. Invasive fungal infections in patients with hematologic malignancies in a tertiary care cancer center: an autopsy study over a 15-year period (1989-2003). Haematologica 2006; 91:986.
5. HACHEM R. HANNA H. KONTOYIANNIS D. JIANG Y. RAAD I. The changing epidemiology of invasive candidiasis: Candida glabrata and Candida krusei as the leading causes of candidemia in hematologic malignancy. Cancer 2008; 112:2493.
6. CORNELY O.A. GACHOT B. AKAN H. BASSETTI M. UZUN O. KIBBLER C. et al. Epidemiology and outcome of fungemia in a cancer Cohort of the Infectious Diseases Group (IDG) of the European Organization for Research and Treatment of Cancer (EORTC 65031). Clin Infect Dis 2015; 61:324.
7. PAGANO L. AKOVA M. DIMOPOULOS G. HERBRECHT R. DRGONA L. BLIJLEVENS N. Risk assessment and prognostic factors for mould-related diseases in immunocompromised patients. J Antimicrob Chemother 2011; 66 Suppl 1:i5.
8. FREIFIELD A.G. BOW E.J. SEPKOWITZ K.A. BOECKH M.J. ITO J.I. MULLEN C.A. et al.Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of America. Clin Infect Dis 2011; 52:e56.
9. National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology. Prevention and treatment of cancer-related infections. Version 2. 2014. http://www.nccn.org (Accessed on July 24 2016).
10. MAERTENS J. MARCHETTI O. HERBRECHT R. CORNELY O.A. FLUCKIGER U. FRERE P. et al. European guidelines for antifungal management in leukemia and hematopoietic stem cell transplant recipients: summary of the ECIL 3-2009 update. Bone Marrow Transplant 2011; 46:709.
11. CORNELY O.A. BOHME A. BUCHHEIDT D. EINSELE H. HEINZ W.J. KARTHAUS M. et al. Primary prophylaxis of invasive fungal infections in patients with hematologic malignancies. Recommendations of the Infectious Diseases Working Party of the German Society for Haematology and Oncology. Haematologica 2009; 94:113.
12. SEGAL B.H. FREIFIELD A.G. BADEN L.R. BROWN A.E. CASPER C. DUBBERKE E. GELFAND M. et al. Prevention and treatment of cancer-related infections. J Natl Compr Cancer Netw 2008 6(2):122-174.
13. CICHRA A. MAKARYUS M. CHAUDHRI P. NARASIMHAN M. Ultrasound for the pulmonary consultant. Clin Med Insights Circ Respir Pulm Med. 2016; 10:1-9.
14. SPERANDEO M. FILABOZZI P. VARRIALE A. CARNEVALE V. PIATELLI M.L. SPERANDEO G. et al. Role of thoracic ultrasound in the assessment of pleural and pulmonary diseases. J Ultrasound. 2008; 11(2):39-46.
15. DOHNER H. WEISDORF D.J. BLOOMFIELD C.D. Acute myeloid leukemia. N Engl J Med. 2015; 373(12):1136-52.
16. FISCHER R.I. GAYNOR E.R. DAHLBERG S. OKEN M.M. GROGAN T.M. MIZE E.M. et al. Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin's lymphoma. N Engl J Med. 1993; 328(14):1002-6.
17. JAGANNATH S. DURIE B.G. WOLF J. CAMACHO E. IRWIN D. LUTZKY J. et al. Bortezomib therapy alone and in combination with dexamethasone for previously untreated symptomatic multiple myeloma. Br J Haematol. 2005; 129(6):776-83.