Abstract
This study investigated the epidemiology and risk factors associated with invasive fungal infections (IFIs) during induction chemotherapy in a cohort of Taiwanese patients with newly-diagnosed acute myeloid leukemia (AML). IFIs are a significant complication in the management of immunocompromised cancer patients; such infections are associated with a high incidence of morbidity and mortality, particularly in many South-Asian countries, where IFI rates are increasing. We retrospectively analyzed IFI incidence data from 105 patients with newly diagnosed AML at a single center undergoing their first course of induction chemotherapy without primary antifungal prophylaxis between November 2008 and December 2014. Of 21 cases documented as proven/provable IFIs 16 (76%) were invasive aspergillosis, 2 (10%) were mucormycosis infections, and 3 (14%) were proven yeast infections. The lung was the most commonly affected site (n = 16; 76%); 2 patients (10%) developed fungal sinusitis. IFI cases were more often males (P = 0.020). In multivariate analysis, patients with neutropenia lasting>30 days were more than twice as likely to develop IFI (OR, 2.24 [95% CI, 2.81–31.11], P<0.001). We also confirmed patients with smoker and receiving parenteral nutrition during chemotherapy were significant associated with IFIs. Our findings suggest that antifungal prophylaxis should be considered for patients with AML during induction chemotherapy, particularly in patients from Southeastern Asia, an area of potentially high IFI rates. We recommend that clinicians determine which patients receiving induction chemotherapy for AML are at high risk of developing IFI, to allow for targeted therapeutic prophylaxis.
Highlights
Despite recent advances in the field of hematologic malignancies, such as non-invasive biomarkers for early diagnosis, radiographic screening and the widespread use of novel antifungal drugs[1, 2], invasive fungal infections (IFIs) remain a major cause of morbidity and mortality in patients with acute myeloid leukemia (AML)[3, 4]
Response to induction chemotherapy was undefined in three patients; these patients had no data from a bone marrow examination after chemotherapy
This retrospective cohort study confirmed a high incidence of IFI in AML patients undergoing induction chemotherapy
Summary
Despite recent advances in the field of hematologic malignancies, such as non-invasive biomarkers for early diagnosis, radiographic screening and the widespread use of novel antifungal drugs[1, 2], invasive fungal infections (IFIs) remain a major cause of morbidity and mortality in patients with acute myeloid leukemia (AML)[3, 4]. In 2015, a 2-year observational study determined that the epidemiology of invasive fungal diseases among patients with hematologic disorders in 8 Asian countries/regions was similar to that in Western centers, with an overall 30-day mortality of 22.1%[5]. The patient population did not consist of high-risk individuals. Another recent report has indicated a high incidence of IFI in AML patients receiving induction chemotherapy in Southeastern Asia[6]. Stratifying patients at risk for IFI could potentially determine those who would be most likely to benefit from more intensive antifungal treatment. The present study sought to describe the epidemiology, clinical characteristics, risk factors and outcomes of IFI in patients with newly diagnosed AML receiving their first induction treatment in Taiwan, in a setting that did not routinely use primary antifungal prophylaxis
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