{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T09:46:41Z","timestamp":1761126401350,"version":"build-2065373602"},"reference-count":32,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2003,5,28]],"date-time":"2003-05-28T00:00:00Z","timestamp":1054080000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2003,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>BACKGROUND<\/jats:title><jats:p>Invasive fungal infections, including candidemia, pose a major threat to patients with impaired immune defenses, including bone marrow transplantation (BMT) recipients. During 1992\u20131997, 845 women with multiple lymph node positive or metastatic breast carcinoma underwent high\u2010dose chemotherapy (HDC) and subsequent autologous BMT at Duke University Medical Center. No systemic antifungal prophylaxis was administered. The purpose of the current study was to evaluate the risk and long\u2010term outcome of candidemia in this patient population.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>Clinical data were collected on patients with candidemia, and a group of age\u2010matched control patients were identified who underwent HDC and BMT for breast carcinoma in the same time period. The difference in crude mortality between these two groups was used to calculate the attributable mortality of candidemia. The genetic relatedness of the fungal blood stream isolates was investigated by DNA fingerprinting. Antifungal susceptibility testing was performed using serial microdilution.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Twenty\u2010nine of 845 women developed candidemia (3.4%). The crude mortality of women with candidemia was 35% at 90 days after transplantation but 11% among women in the matched control group who were without infection (<jats:italic>P<\/jats:italic> = 0.01), for an attributable mortality rate of 24%. The most common pathogen was <jats:italic>Candida tropicalis<\/jats:italic> (50%), followed by <jats:italic>Candida albicans<\/jats:italic> (23%). The mortality was highest for women who were infected with <jats:italic>C. albicans<\/jats:italic>, followed by <jats:italic>C. tropicalis<\/jats:italic>, and other <jats:italic>Candida<\/jats:italic> species (<jats:italic>P<\/jats:italic> = 0.037). DNA fingerprinting of the yeasts revealed genetic heterogeneity in all species. However, 9 of 15 <jats:italic>C. tropicalis<\/jats:italic> isolates had identical DNA fingerprint profiles, suggesting spread of this genotype from a common source. All yeast isolates were susceptible to amphotericin B, and 20 of 30 isolates were susceptible to \u2264 8 \u03bcg\/mL of fluconazole.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Candidemia was relatively infrequent after HDC and autologous BMT in women with for multiple lymph node positive or metastatic breast carcinoma. This was true even in the absence of systemic antifungal prophylaxis. The mortality attributable to candidemia in this patient population was 24% and was higher among patients who were infected by <jats:italic>C. albicans<\/jats:italic> compared with patients who were infected by other <jats:italic>Candida<\/jats:italic>, non\u2010<jats:italic>albicans<\/jats:italic> species. Cancer 2003;98:24\u201330. \u00a9 2003 American Cancer Society.<\/jats:p><jats:p>DOI 10.1002\/cncr.11470<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncr.11470","type":"journal-article","created":{"date-parts":[[2003,6,23]],"date-time":"2003-06-23T12:15:02Z","timestamp":1056370502000},"page":"24-30","source":"Crossref","is-referenced-by-count":16,"title":["Candidemia in women with breast carcinoma treated with high\u2010dose chemotherapy and autologous bone marrow transplantation"],"prefix":"10.1002","volume":"98","author":[{"given":"Magn\u00fas","family":"Gottfredsson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James J.","family":"Vredenburgh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianping","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wiley A.","family":"Schell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John R.","family":"Perfect","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2003,5,28]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V96.6.2055"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/164.4.731"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1994.12.5.1005"},{"issue":"35","key":"e_1_2_7_5_2","first-page":"11","article-title":"A large, prospective, randomized trial of high dose combination alkylating agents (CPB) with autologous cellular support (ABMS) as consolidation for patients with metastatic breast cancer achieving complete remission after intensive doxorubicin\u2010based induction therapy (AFM)","volume":"37","author":"Peters WP","year":"1996","journal-title":"Br Cancer Res Treat."},{"key":"e_1_2_7_6_2","unstructured":"National Committee for Clinical Laboratory Standards.Reference method for broth dilution antifungal susceptibility testing of yeasts. Approved standard. Document M\u201027A.Wayne:National Committee for Clinical Laboratory Standards 1997."},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.2.6.423"},{"key":"e_1_2_7_8_2","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1128\/JCM.38.3.1214-1220.2000","article-title":"Clonal and spontaneous origins of fluconazole resistance in Candida albicans","volume":"38","author":"Xu J","year":"2000","journal-title":"J Clin Microbiol."},{"key":"e_1_2_7_9_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.34.3.615-621.1996"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1086\/515379"},{"volume-title":"Biometry","year":"1981","author":"Sokal RR","key":"e_1_2_7_11_2"},{"volume-title":"Principles of population genetics","year":"1989","author":"Hartl DL","key":"e_1_2_7_12_2"},{"volume-title":"PAUP4.5: phylogenetic analysis using parsimony","year":"2001","author":"Swofford DL","key":"e_1_2_7_13_2"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1086\/318491"},{"key":"e_1_2_7_15_2","doi-asserted-by":"publisher","DOI":"10.1086\/319763"},{"key":"e_1_2_7_16_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-91-4-539"},{"key":"e_1_2_7_17_2","doi-asserted-by":"publisher","DOI":"10.1086\/323812"},{"key":"e_1_2_7_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/00075198-199910000-00008"},{"key":"e_1_2_7_19_2","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.60.11.4907-4914.1992"},{"key":"e_1_2_7_20_2","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1128\/iai.29.2.808-813.1980","article-title":"Pathogenicity of Candida tropicalis and Candida albicans after gastrointestinal inoculation of mice","volume":"29","author":"Wingard JR","year":"1980","journal-title":"Infect Immun."},{"key":"e_1_2_7_21_2","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1128\/iai.37.2.833-836.1982","article-title":"Differences in virulence of Candida tropicalis and Candida albicans","volume":"37","author":"Wingard JR","year":"1982","journal-title":"Infect Immun."},{"key":"e_1_2_7_22_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.42.11.2938"},{"key":"e_1_2_7_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0732-8893(00)00165-6"},{"key":"e_1_2_7_24_2","doi-asserted-by":"publisher","DOI":"10.1053\/jinf.2000.0638"},{"key":"e_1_2_7_25_2","doi-asserted-by":"publisher","DOI":"10.1086\/647743"},{"key":"e_1_2_7_26_2","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1128\/iai.61.4.1268-1271.1993","article-title":"Experimental hematogenous candidiasis caused by Candida krusei and Candida albicans: species differences in pathogenicity","volume":"61","author":"Anaissie E","year":"1993","journal-title":"Infect Immun."},{"key":"e_1_2_7_27_2","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.69.8.5046-5055.2001"},{"key":"e_1_2_7_28_2","doi-asserted-by":"publisher","DOI":"10.1086\/514731"},{"key":"e_1_2_7_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(01)01130-5"},{"key":"e_1_2_7_30_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.160.17.2659"},{"key":"e_1_2_7_31_2","doi-asserted-by":"publisher","DOI":"10.1086\/315193"},{"key":"e_1_2_7_32_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1988.00380120094019"},{"key":"e_1_2_7_33_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.37.12.3835-3843.1999"}],"container-title":["Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fcncr.11470","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncr.11470","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T14:26:13Z","timestamp":1760279173000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cncr.11470"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2003,5,28]]},"references-count":32,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2003,7]]}},"alternative-id":["10.1002\/cncr.11470"],"URL":"https:\/\/doi.org\/10.1002\/cncr.11470","archive":["Portico"],"relation":{},"ISSN":["0008-543X","1097-0142"],"issn-type":[{"type":"print","value":"0008-543X"},{"type":"electronic","value":"1097-0142"}],"subject":[],"published":{"date-parts":[[2003,5,28]]}}}