Abstract
Invasive fungal infections (IFIs) is an important complication for acute myeloid leukemia (AML) patients receiving induction chemotherapy. However, the epidemiological information is not clear in Southeastern Asia, an area of potential high incidences of IFIs. To clarify it, we enrolled 298 non-M3 adult AML patients receiving induction chemotherapy without systemic anti-fungal prophylaxis from Jan 2004 to Dec 2009, when we applied a prospective diagnostic and treatment algorithm for IFIs. Their demographic parameters, IFI characters, and treatment outcome were collected for analysis. The median age of these patients was 51 years. Standard induction chemotherapy was used for 246 (82.6%) patients, and 66.8% of patients achieved complete remission (CR) or partial remission. The incidence of all-category IFIs was 34.6% (5.7% proven IFIs, 5.0% probable IFIs and 23.8% possible IFIs). Candida tropicalis was the leading pathogen among yeast, and lower respiratory tract was the most common site for IFIs (75.4%, 80/106). Standard induction chemotherapy and failure to CR were identified as risk factors for IFIs. The presence of IFI in induction independently predicted worse survival (hazard ratio 1.536 (1.100–2.141), p value = 0.012). Even in those who survived from the initial IFI insults after 3 months, the presence of IFIs in induction still predicted a poor long-term survival. This study confirms high incidences of IFIs in Southeastern Asia, and illustrates potential risk factors; poor short-term and long-term outcomes are also demonstrated. This epidemiological information will provide useful perspectives for anti-fungal prophylaxis and treatment for AML patients during induction, so that best chances of cure and survival can be provided.
Highlights
The control of bacterial infections in patients with hematological malignancies has been significantly improved with broad-spectrum antibiotics in the past decades, treating invasive fungal infections (IFI) is still a major problem in these patients, especially in patients with prolonged neutropenia after chemotherapy
The median follow-up time for survival was 16.6 month, and the overall time subjected to the evaluation for IFIs after induction chemotherapy was 371.1 patient-months
Antecedent hematologic diseases were noted in 19.1% (57/298) of the patients, including 34 with myelodysplastic syndrome (MDS) and 18 with myeloproliferative neoplasms (MPNs)
Summary
The control of bacterial infections in patients with hematological malignancies has been significantly improved with broad-spectrum antibiotics in the past decades, treating invasive fungal infections (IFI) is still a major problem in these patients, especially in patients with prolonged neutropenia after chemotherapy. The epidemiology of IFI in patients with hematological malignancies in subtropic or tropic regions should be different due to favorable fungal growth conditions, but to date, there is no convincing data available for patients in these regions. Other factors such as the genetic background of patients, chemotherapeutic regimens or environmental settings contribute to the geographic variation in IFI epidemiology of these patients[13]. We will illustrate the potential risk factors for IFIs, and the potential short-term or long-term prognostic impacts of IFIs on the survival of these patients These results should provide useful perspectives in establishing guidelines for anti-fungal prophylaxis in Southeastern Asia, and treatment in patients with hematological malignancies
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