Background: Invasive fusariosis (IF) is a rare but often fatal mold infection in immunocompromised patients, particularly after allogeneic hematopoietic stem cell transplantation (HSCT). Despite antifungal prophylaxis and treatment, mortality remains high.
Methods: We retrospectively reviewed all allogeneic HSCT recipients for hematological malignancies at our center (2010-2024) and identified proven IF cases. Species identification was based on multigene sequencing, and antifungal susceptibility testing was performed.
Results: Among 2359 allogeneic HSCTs, 17 proven IF cases (7.2/1000) were identified. Patients more often had prior HSCT (58.8% vs. 19.8%, p = 0.002) and were transplanted in non-complete remission (94.1% vs. 75.8%). Median onset was 19 days (range, 2-1011) posttransplant, with a median neutrophil count of 1/µL (range, 1-7097) at diagnosis; 64.7% were pre-engraftment. Prophylaxis included micafungin (n = 10), posaconazole (n = 4), and voriconazole (n = 3). Species: Fusarium solani complex (n = 11), Fusarium dimerum complex (n = 4), and Fusarium fujikuroi complex (n = 2). All isolates had high micafungin MECs (> 16 µg/mL); the median amphotericin B MIC was 4 µg/mL, voriconazole MIC > 8 µg/mL. Median overall survival was 8 days; mortality reached 82.4% by Day 84. In univariate analysis, combination liposomal amphotericin B (L-AMB) plus voriconazole (p = 0.013) and neutrophil recovery (p = 0.008) were associated with improved survival. No clear trends were noted in antifungal susceptibility between survivors and non-survivors.
Conclusions: IF after allogeneic HSCT is rare but highly lethal. Despite the small sample size, outcomes were not clearly associated with MIC values. Early L-AMB plus VRCZ and neutrophil recovery may be associated with improved survival.
Keywords: Fusarium species; allogeneic hematopoietic stem cell transplantation; antifungal susceptibility; invasive fusariosis; neutrophil recovery.
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