Clinical Characteristics and Outcomes of invasive Lomentospora prolificans Infections: Analysis of Patients in the FungiScope® Registry

OBJECTIVES: Invasive fungal infections caused by Lomentospora prolificans are associated with very high mortality rates and can be challenging to treat given pan-drug resistance to available antifungal agents. The objective of this study was to describe the clinical presentation and outcomes in a cohort of patients with invasive L. prolificans infections. METHODS: We performed a retrospective review of medical records of patients with invasive L. prolificans infection in the FungiScope(R) registry of rare invasive fungal infections. Patients diagnosed between 01/01/2008 - 09/09/2019 were included in for analysis. RESULTS: The analysis included 41 patients with invasive L. prolificans infection from eight different countries. Haematological/oncological malignancies were the most frequent underlying disease (66%), disseminated infection was frequent (61%), and the lung was the most commonly involved organ (44%). Most infections (59%) were breakthrough infections. Progression/deterioration/treatment failure was observed in 23/40 (58%) of patients receiving antifungal therapy. In total, 21/41 (51%) patients, and 77% of patients with underlying haematological/oncological malignancy, had a fatal outcome attributed to invasive fungal infection. Combination antifungal therapy was frequent (24/40) and associated with improved survival. In particular, treatment regimens including terbinafine were significantly associated with higher treatment success at final assessment (p=0.012), with a positive trend observed for treatment regimens that included voriconazole (p=0.054). CONCLUSIONS: L. prolificans infections were associated with mortality rates of 77% and above in patients with underlying haematological/oncological malignancies and those with disseminated infections. While combination therapy is the preferred option for now, the hope lies with novel antifungals currently under development.