Quantifying Adherence to Mucormycosis Treatment Guidelines in Patients With Hematologic Malignancies

Adhering to mucormycosis treatment guidelines may be difficult for physicians because of the complexity of the disease.

The European QUALity (EQUAL) Mucormycosis Score may help quantify adherence to current guideline recommendations for treatment of patients with mucormycosis, according to research published in the Journal of Antimicrobial Chemotherapy.

Mucormycosis is a rare disease that occurs in immunocompromised patients as well as patients with hematologic malignancies and is associated with a highly complex diagnosis and management. Current guidelines for the treatment of mucormycosis list more than 80 recommendations for diagnosis and treatment, making adherence to these guidelines difficult for physicians. It is unknown whether adherence to guidelines, especially those related to disease diagnosis, is correlated with mortality or treatment outcomes.

The EQUAL Mucormycosis Score is an 18-item tool divided into 3 main categories — diagnosis, treatment, and follow-up — that measures adherence to mucormycosis treatment guidelines. It was developed based on recommendations from 4 major society guidelines. Each item is given a point value, and the maximum achievable score per patient ranges between 25 to 32 points depending on the patient’s individual circumstances.

Researchers conducted a retrospective chart review and applied the EQUAL Mucormycosis Score to 11 patients with mucormycosis treated from January 2017 to April 2018, 9 of whom had hematologic malignancies. Over the duration of treatment, 200 (62.7%) of the 319 points possible were achieved. The total points achieved in each of the 3 main categories were 112 of 165 (67.9%) for diagnosis, 54 of 88 (61.4%) for treatment, and 34 of 66 (51.5%) for follow-up.

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The mortality rate at both day 100 and 1 year was 72.7%. Median survival was 38 days.

Though it was unclear whether the EQUAL Mucormycosis Score was associated with improved outcomes or survival, the authors noted that the tool provided an important reference point for future research. They concluded that they “aligned the EQUAL Mucormycosis Score exclusively towards hematology patients,” but further studies are warranted to evaluate the association between guideline adherence and treatment outcomes in other immunocompromised patients with mucormycosis.


Koehler P, Mellinghoff SC, Lagrou K, et al. Development and validation of the European QUALity (EQUAL) score for mucormycosis management in hematology [published online February 15, 2019]. J Antimicrob Chemother. doi: 10.1093/jac/dkz051

This article originally appeared on Hematology Advisor