Incidence and outcome of invasive fungal disease after front-line intensive chemotherapy in patients with acute myeloid leukemia: impact of antifungal prophylaxis.
Rebeca Rodríguez-VeigaPau MontesinosBlanca BoludaIgnacio LorenzoDavid Martínez-CuadrónMiguel SalavertJavier PemánPilar CalvilloIsabel CanoEvelyn AcuñaAna VillalbaJosé Luis PiñanaJaime SanzPilar SolvesLeonor SenentAna VicenteAmparo SempereJosé CerveraEva BarragánIsidro JarqueAntonio TorresMiguel A SanzGuillermo F SanzPublished in: Annals of hematology (2019)
Few reports analyze the incidence and clinical outcome of invasive fungal disease (IFD) in patients with newly diagnosed acute myeloid leukemia (AML) undergoing intensive chemotherapy, and thus the impact of different antifungal prophylactic regimens remains unclear. We analyze the incidence and clinical outcome of IFD in a large series of adult AML patients undergoing front-line intensive induction and consolidation chemotherapy between 2004 and 2015 in a single institution. Three antifungal prophylaxis regimens were given (2004-2005 oral fluconazole, 2006-2012 intravenous itraconazole, and 2013-2015 voriconazole). Overall, 285 patients and 589 intensive chemotherapy episodes were assessed (47%) (induction courses 47% and consolidation 53%). The median age was 51 years (range, 17-65). We observed 56 (10%) episodes of IFD. According to the EORTC 2008 criteria, IFD was classified as possible (29, 52%), probable (17, 30%), and proven (10, 18%). Possible/probable/proven IFD rate was significantly lower during HiDAC consolidation as compared to any anthracycline-containing chemotherapy courses (2% vs. 11%, P = 0.001), and under voriconazole prophylaxis as compared to itraconazole and fluconazole (6% vs. 11% vs. 15%, P = 0.007), and the multivariate analysis showed that they were independent risk factors. Patients under voriconazole prophylaxis had shorter hospitalization duration and less frequent use of empirical or directed antifungal therapy. In conclusion, IFD was a frequent complication during upfront intensive chemotherapy courses for adult AML patients. This retrospective study shows that voriconazole prophylaxis was feasible and associated with a lower risk of IFD compared with intravenous itraconazole or oral fluconazole schedules.
Keyphrases
- acute myeloid leukemia
- newly diagnosed
- candida albicans
- risk factors
- end stage renal disease
- ejection fraction
- locally advanced
- patients undergoing
- prognostic factors
- peritoneal dialysis
- stem cells
- allogeneic hematopoietic stem cell transplantation
- squamous cell carcinoma
- emergency department
- patient reported outcomes
- radiation therapy
- smoking cessation
- electronic health record
- cell therapy
- water quality