The relationship of cigarette smoking to invasive fungal disease (IFD) in acute myeloid leukemia (AML) patients undergoing induction chemotherapy (IC).

Abstract

6547 Background: Marijuana use has been linked with IFD in immunocompromised patients. Although cigarettes also contain aspergillus spores, the effect of being a cigarette smoker (CS) on developing IFD has not before been established in this population. We investigated whether being a CS increased the risk of IFD in AML patients (pts) undergoing IC. We defined IFD as proven, probable or possible using the Revised Infectious Diseases Society of America (IDSA) guidelines. Methods: We conducted a retrospective review of all AML pts treated with cytarabine-based IC at Cleveland Clinic between 1994 and 2008. Data on age, race, AML etiology, FAB or WHO classification, WBC at diagnosis (dx), cytogenetics, consolidation therapy, marijuana use, steroid use prior to AML dx, bone marrow transplant (BMT), timing of IFD, pack yrs, past smoking status, and achievement of complete remission (CR) were collected and controlled for in multivariable analyses. A logistic regression was used to assess the association between being a CS and IFD, and being a CS and overall survival (OS). Results: Mean age was 58 yrs (range, 17- 92). Of 741 pts, 45% were female, 27% had secondary AML, 24% were current CS, 18% were past CS, 3% used marijuana, and 36% developed IFD. Compared to non-smokers (NS), CS were significantly younger (53 vs. 60 yrs, p < 0.0001), more likely to be male (48% vs. 38%, p = 0.023), to have de novo AML (76% vs. 64%, p = 0.011), to use marijuana (11% vs. 0.2%, p < 0.0001), and to develop IFD (89% (proven/probable/possible = 8%/53%/28%) vs. 19%, p < 0.0001). Overall, 53% of pts achieved CR. There were no differences between groups in FAB, cytogenetics, WBC, time from admission to IC, pack yrs, chronic steroid use prior to AML dx, developing IFD post BMT, consolidation, and achieving a CR. Median OS for CS vs. NS were 0.64 vs. 0.84 yrs, p = 0.23. In multivariable analyses, smoking remained significantly associated with IFD (hazard ratio 39.4, p value < 0.0001). Conclusions: Even after adjusting for patient disease, prognostic factors, and treatment factors that could influence IFD, CS who underwent IC were significantly more likely to develop IFD, and should be considered for intensive antifungal prophylaxis. No significant financial relationships to disclose.