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    Doenças fúngicas invasivas em pacientes oncohematológicos e receptores de transplante de células-tronco hematopoéticas: série histórica e aspectos evolutivos
    (Universidade Federal de São Paulo (UNIFESP), 2021) Bergamasco, Maria Daniela Di Dea [UNIFESP]; Colombo, Arnaldo Lopes [UNIFESP]; Universidade Federal de São Paulo
    Objective: To describe the epidemiology of invasive fungal diseases (IFDs) in hematologic patients and hematopoietic cell transplant (HCT) recipients, managed with fluconazole prophylaxis and an antifungal diagnostic-driven approach for mold infection. Methods: This is a retrospective, single-center cohort study of all consecutive cases of proven or probable IFDs according to the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) diagnosed between 2009 and 2019 (11-year period), in adult hematologic patients and HCT recipients, managed with fluconazole prophylaxis and an antifungal diagnostic-driven approach for mold infection. Cases of possible IFDs and pneumocistosis were excluded from analysis. Results: During the study period, 94 cases of IFDs occurred among 664 hematologic patients and 316 HCT recipients. The frequency of IFDs among patients with allogeneic HCT, autologous HCT, acute leukemia and other hematologic malignancies was 8.9%, 1.6%, 17.3%, and 6.4%, respectively. Aspergillosis was the leading IFD (53.2%), followed by fusariosis (18.1%), candidiasis (10.6%), and cryptococcosis (8.5%).The overall 6-week mortality rate was 37.2%, and varied according to the host and the etiology ofIFD, from 28% in aspergillosis to 52.9% in fusariosis. Although IFDs occurred frequently in our cohort of patients managed with an antifungal diagnostic driven approach, mortality rates were comparable to other studies. In the face of challenges posed by the use of anti-mold prophylaxis, this strategy remains a reasonable alternative.