Background: Newly diagnosed patients with acute myeloid leukemia (AML) who receive induction with a hypomethylating agent (HMA) are often neutropenic with an increased risk for invasive fungal infections (IFIs). This study analyzed the incidence and risk factors for IFIs in these patients, evaluated clinical patterns in antifungal prophylaxis, and assessed the diagnostic utility of tests in this setting. Patients and Methods: We studied 117 newly diagnosed patients with AML treated with HMAs at our center, divided into groups based on concern for IFI (cIFI: all possible, probable, and proven IFIs) versus no concern for IFI. The Fisher exact test compared patients with cIFI versus without, and a multivariable logistic regression model estimated odds for cIFI. Results: Sixty-seven (57%) patients had cIFI, with 48 possible IFIs, 17 probable, and 2 proven cases. There was no difference in incidence based on home zip code, but the presence of chronic obstructive pulmonary disease was highly associated with cIFI (P = .001), as was male gender (P = .01). Neutropenia at treatment initiation was borderline in significance (P = .08). In diagnostics, 9% of patients had positive serum fungal markers, and 30 patients underwent bronchoscopy, with only 27% of cases yielding positive results. There was a difference in treatment regimens between patients receiving antifungal prophylaxis with mold coverage versus without mold coverage with respect to cIFI (P = .04). Conclusions: cIFI in patients with AML treated with HMAs remains significant, especially in males and those with chronic obstructive pulmonary disease, who were found to be at higher risk. This may prompt clinicians to consider anti-mold prophylaxis in this setting.
Bibliographical noteFunding Information:
JS Blachly reports a consulting/advisory role for AstraZeneca and Kite Pharma; travel/accommodations/expense from Oxford Nanopore Technologies; patents: a sequencing technology patent pending; and honoraria from LifeSci Venture Partners. AR Walker reports travel/accommodations/expense from Gilead Sciences; and research funding from Gilead Science s. AS Mims reports a consulting/advisory role for Astellas Pharma, Agios, PTC Therapeutics, Jazz Pharmaceuticals, Abbvie/Genentech, Syndax Pharmaceuticals, and Kura Oncology, Inc. The remaining authors have stated that they have no conflicts of interest.
Research reported in this publication was supported by the Division of Hematology and Infectious Disease at The Ohio State University and James Comprehensive Cancer Center , with all authors listed above as assisting in the critical appraisal of its scientific work and writing of this manuscript. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
- Acute myeloid leukemia
- Anti-mold azoles
- Antifungal prophylaxis
- Risk stratification
PubMed: MeSH publication types
- Journal Article