BACKGROUND: Our multicentre study aims to identify baseline factors and provide guidance for therapeutic decisions regarding Magnusiomyces-associated infections, an emerging threat in patients with haematological malignancies. METHODS: HM patients with proven (Magnusiomyces capitatus) M. capitatus or (Magnusiomyces clavatus) M. clavatus (formerly Saprochaete capitata and Saprochaete clavata) infection diagnosed between January 2010 and December 2020 were recorded from the SEIFEM (Sorveglianza Epidemiologica Infezioni nelle Emopatie) group and FungiScope (Global Emerging Fungal Infection Registry). Cases of Magnusiomyces fungemia were compared with candidemia. RESULTS: Among 90 Magnusiomyces cases (60 [66%] M. capitatus and 30 (34%) M. clavatus), median age was 50 years (range 2-78), 46 patients (51%) were female and 67 (74%) had acute leukaemia. Thirty-six (40%) of Magnusiomyces-associated infections occurred during antifungal prophylaxis, mainly with posaconazole (n = 13, 36%) and echinocandins (n = 12, 34%). Instead, the candidemia rarely occurred during prophylaxis (p < .0001). First-line antifungal therapy with azoles, alone or in combination, was associated with improved response compared to other antifungals (p = .001). Overall day-30 mortality rate was 43%. Factors associated with higher mortality rates were septic shock (HR 2.696, 95% CI 1.396-5.204, p = .003), corticosteroid treatment longer than 14 days (HR 2.245, 95% CI 1.151-4.376, p = .018) and lack of neutrophil recovery (HR 3.997, 95% CI 2.102-7.601, p < .001). The latter was independently associated with poor outcome (HR 2.495, 95% CI 1.192-5.222, p = .015). CONCLUSIONS: Magnusiomyces-associated infections are often breakthrough infections. Effective treatment regimens of these infections remain to be determined, but neutrophil recovery appears to play an important role in the favourable outcome.

Clinical Microbiology and Parasitology Department University Hospital La Paz Madrid Spain

Clinical Trials Centre Cologne Faculty of Medicine and University Hospital Cologne University of Cologne Cologne Germany

Department 1 of Internal Medicine Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf Faculty of Medicine and University Hospital Cologne University of Cologne Cologne Germany

Department of Clinical Mycology Allergy and Immunology North Western State Medical University St Petersburg Russia

Department of Hematology Centre Henri Becquerel Rouen France

Department of Hematology Hospital Universitario Puerta de Hierro Majadahonda Madrid Spain

Department of Infectious Diseases Faculty of Medicine Erciyes University Kayseri Turkey

Department of Internal Medicine Hematology and Oncology Masaryk University Hospital Brno Brno Czech Republic

Department of Pediatric Hematology and Oncology Teaching Hospital Motol 2nd Medical School Charles University Motol Prague Prague Czech Republic

Department of Pediatric Hematology Faculty of Medicine Children's Hospital Ege University Izmir Turkey

Department of Physiology Brno Czech Republic Institute of Hematology and Blood Transfusion Masaryk University Prague Czech Republic

Dipartimento di Biomedicina e Prevenzione Università degli studi di Roma Tor Vergata Roma Italy

Dipartimento di Diagnostica per Immagini Radioterapia Oncologica ed Ematologia Fondazione Policlinico Universitario A Gemelli IRCCS Roma Roma Italy

Dipartimento di Medicina Clinica e Molecolare Azienda Ospedaliera Universitaria Sant'Andrea di Roma Università Sapienza di Roma Roma Italy

Division of Hematology ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi Varese Italy

Division of Hematology Department of Internal Medicine and Oncology Semmelweis University Budapest Hungary

Divisione di Ematologia ASST Spedali Civili di Brescia Brescia Italy

Ematologia e Trapianto di Cellule Staminali Ospedale Vito Fazzi Lecce Italy

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico UOC di Ematologia Milano Italy

German Centre for Infection Research Partner Site Bonn Cologne Cologne Germany

Hematology and Stem Cell Transplant Unit IRCCS Regina Elena National Cancer Institute Roma Italy

Hospital de la Santa Creu i Sant Pau Barcelona Spain

Institute of Haematology and Blood Transfusion Prague Czech Republic

Istituto di Ematologia ed Oncologia Medica L e A Seragnoli Ospedale Sant'Orsola Malpighi Bologna Italy

Istituto di Ematologia Fondazione Policlinico Universitario A Gemelli IRCSS Università Cattolica del Sacro Cuore Roma Italy

National Reference Laboratory for Medical Mycology Institute of Microbiology and Immunology Faculty of Medicine University of Belgrade Belgrade Serbia

Onco Hematology Department of Oncology Veneto Institute of Oncology IOV IRCCS Padua Italy

Pediatric Hematology Oncology Department of Mother and Child Azienda Ospedaliera Universitaria Integrata di Verona Verona Italy

Schneider Children's Medical Center Faculty of Medicine Tel Aviv University Tel Aviv Israel

Sezione di Ematologia Dipartimento dell'Emergenza e dei Trapianti d'Organo Università di Bari Bari Italy

Stem Cell Transplant Center AOU Citta' della Salute e della Scienza Torino Italy

Translational Research Cologne Excellence Cluster on Cellular Stress Responses in Aging Associated Diseases Faculty of Medicine and University Hospital Cologne University of Cologne Cologne Germany

U O C Ematologia P O A Tortora Pagani Salerno Italy

Unità Operativa Complessa di Ematologia Azienda Ospedaliera Universitaria Integrata di Verona Verona Italy

UOC Ematologia e Trapianto di Cellule Staminali Emopoietiche Policlinico Riuniti Foggia Foggia Italy

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