The use of immunosuppressive therapy is strongly associated with an increased risk of death in patients with pulmonary mucormycosis (PM) and non-hematologic malignancies (NHMs), according to new research. The study also identified solid organ transplantation (SOT) as an important predictor of poor outcomes, highlighting the need for early recognition and aggressive management in these high-risk patients.
Pulmonary mucormycosis is a rare but life-threatening invasive fungal infection that has traditionally been associated with patients with hematologic malignancies. However, its clinical features and outcomes in patients with solid tumours and other non-hematologic malignancies remain poorly understood.
Examining Pulmonary Mucormycosis in Non-Hematologic Malignancies
Researchers conducted a retrospective study at Beijing Chaoyang Hospital, including 46 patients diagnosed with pulmonary mucormycosis between March 2017 and July 2024 who had underlying non-hematologic malignancies.
The primary outcome was all-cause mortality within 90 days of diagnosis. Clinical characteristics, laboratory findings, treatment variables, and survival outcomes were analysed using Kaplan-Meier survival curves and Cox regression models.
Diabetes mellitus was the most common comorbidity, affecting 71.7% of patients.
More Than One-Third of Patients Died Within 90 Days
Overall, the 90-day mortality rate was 37%, with 17 of the 46 patients dying during follow-up.
Compared with survivors, patients who died were more likely to develop respiratory failure, require admission to the intensive care unit, or experience septic shock. They also had lower haemoglobin levels and significantly higher concentrations of D-dimer and procalcitonin, suggesting more severe systemic illness.
Immunosuppressants Identified as Independent Risk Factor
In univariable analyses, several factors were associated with a greater risk of death, including solid organ transplantation, immunosuppressant use, elevated D-dimer, and increased procalcitonin levels.
After adjustment for age, sex, and diabetes, immunosuppressant therapy remained the only independent predictor of 90-day mortality, increasing the risk of death more than sevenfold.
Kaplan-Meier survival analyses similarly demonstrated significantly poorer survival among patients receiving immunosuppressive medications and those with a history of solid organ transplantation.
Findings Support Earlier Intervention
The authors conclude that pulmonary mucormycosis carries a poor prognosis in patients with non-hematologic malignancies, particularly among individuals receiving immunosuppressive therapy or following solid organ transplantation.
They suggest that recognising these high-risk groups may facilitate earlier diagnosis, prompt antifungal treatment, and more intensive clinical management. However, they note that the relatively small sample size means the findings should be confirmed in larger multicentre studies before being incorporated into routine clinical practice.
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