Optimal clinical care and clinical investigation of patients with
mucormycosis are limited by absence of controlled trials, and absence of well-defined predictors of mortality or clinical response. The
Deferasirox-
AmBisome Therapy for
mucormycosis (DEFEAT Mucor) study was the first randomized clinical trial conducted on patients with
mucormycosis, and demonstrated that adjunctive
deferasirox therapy did not improve outcomes of the disease. The current study describes clinical factors from the 20 patients enrolled to identify those associated with 90-day mortality of the 11 (55%) patients who died by day 90. Age,
diabetes mellitus, transplant status, or antifungal
therapy were not associated with mortality. However, active
malignancy or
neutropenia at enrollment were associated with increased mortality. Pulmonary
infection was linked with lower Kaplan-Meier survival compared to non-pulmonary
infection. Higher baseline serum concentrations of
iron and
ferritin were also associated with mortality. No patient who progressed clinically during the first 14 days of study
therapy survived; however, many patients who clinically improved during that time did not survive to 90 days. In contrast, day 30 clinical response was predictive of 90-day survival. These factors may be useful in defining enrollment randomization stratification critieria for future clinical trials, and in supporting clinical care of patients with
mucormycosis.