Surgical treatment of invasive pulmonary mycoses in oncohematological patients after chemotherapy and hematopoietic stem cell transplantation

INTRODUCTION. The role of surgical treatment of invasive mycoses (IM) of the lungs after hematopoietic stem cell transplantation (HSCT) and antitumor chemotherapy (ACT) in patients with oncohematological profile has not been determined. There are only isolated publications on this topic in the scientific medical literature, the presented results are contradictory, and it is difficult to use them to make decisions.

MATERIALS AND METHODS. A retrospective analysis of immediate and long-term treatment results was conducted for patients who underwent ACT and/or HSCT and underwent lung resections for invasive mycosis since 2013. The indications for surgery were the absence of positive dynamics or progressive inflammatory changes in the lungs despite adequate antifungal therapy.

RESULTS. The study included 13 patients, children (n=3) and adults (n=10), 11 males, with a median age of 25 years (ranging from 10 to 64 years). Diagnoses: acute leukemia in 4 patients (31 %), chronic myeloproliferative diseases in 4 patients (31 %), aplastic anemia in 3 patients (23 %), and lymphoma in 2 patients (15 %). In 11 cases (85 %), IM developed in patients after allogeneic HSCT (allo-HSCT), and in 2 cases (15 %) during ACT, with a median development time of 96 days after treatment initiation (ranging from 20 to 510 days). Neutropenia was observed in 46 % of patients (n=6), and platelet counts below 50х10⁹/L in 10 patients (77 %). Bilateral lung changes were present in 54 % of cases (n=7), unilateral lung changes in 46 % of cases (n=6). 5 pneumonectomies, 4 lower lobectomies, 2 upper bilobectomies, 2 atypical lung resections, and 1 upper lobectomy were performed; 2 out of 13 patients (15 %) underwent chest wall resection. One patient died in the early postoperative period (7.7 %). Eight patients (61.5 %) recovered from pulmonary IM with a median follow-up of 118 days (ranging from 42 to 900 days).

CONCLUSIONS. Surgical treatment of IM in this patient group is possible provided that risk factors are eliminated or, more commonly, their severity is reduced (compensation of concomitant conditions, discontinuation of antitumor chemotherapy, transfusions of erythrocyte mass, and platelets). With proper selection of hematological patients with pulmonary IM, the immediate results of surgical treatment can be considered favorable.

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