Invasive fungal sinusitis in patients with hematological malignancies: A 20-year study from a tertiary academic US hospital system
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ID: 313490
2026
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Abstract
Abstract Background Invasive fungal sinusitis (IFS) profoundly impacts individuals with hematological malignancies, with rapid progression and high mortality rates. In an evolving therapeutic landscape, outcomes for patients with hematological malignancies who develop IFS warrant further evaluation. Methods We performed a descriptive case series and retrospective review of patients with hematologic malignancies who developed proven IFS (per EORTC/MSG criteria) between 2005-2024 at a tertiary academic center. Clinical data and outcomes were collected from electronic medical records. Statistical analyses included Fisher’s exact test, t-tests, or Wilcoxon rank-sum tests. Kaplan-Meier curves were used to estimate survival probability, and log-rank tests compared across groups. Results Thirty-one patients with confirmed IFS were identified. Most patients had acute myeloid leukemia (61.3%) and received cytotoxic chemotherapy (96.8%). Targeted oncologic therapies included BCL2-inhibitors (29.0%), FLT3-inhibitors (19.4%), antibody-based therapies (12.9%), BTK-inhibitors (6.4%), and antibody-drug conjugates (6.4%). The most common fungal isolates were Aspergillus (22.6%), Fusarium (16.1%), and Rhizopus (9.7%). Amphotericin B (96.8%) and voriconazole (71.0%) were frequently used, and newer anti-fungals included isavuconazole (38.7%), olorofim (3.3%), and fosmanogepix (3.3%). Necrotic tissue (45.2%) and mucosal thickening (87.1%) were common on sinonasal endoscopy and CT scan, respectively. Orbital (25.8%) and intracranial (9.7%) extension occurred in a minority. Most patients underwent functional endoscopic sinus surgery (80.6%). Serum fungal biomarkers were infrequently positive, with (1,3)-ß-D-glucan in 19.4% and galactomannan in 9.7%. Overall mortality was 71.0% at the end of the study period, with median survival of 101 days (IQR: 21-299 days). Mortality was 22.6% at 1 month, 25.8% at 2 months, 32.3% at 3 months, 41.9% at 6 months, 54.8% at 1 year, 58.1% at 2 years, and 64.5% at 3 years. Conclusions Despite novel therapies and aggressive surgical interventions, patients with IFS had high mortality.
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| Authors | Tejas S. Athni, Carolyn B. Strauch, Victor Kovac, Esther Arbona‐Haddad, Inia Perez Villa, Simran Gupta, Muneerah M Aleissa, Alexis Liakos, Alexandra Tong, Rahul S. Vedula, Alice Z. Maxfield, Regan W. Bergmark, Amy C Sherman |
| Journal | Open forum infectious diseases |
| Year | 2026 |
| DOI |
10.1093/ofid/ofag304
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| URL | |
| Keywords | Keywords not found |
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