Epidemiology, outcomes, and risk factors of invasive fungal infections in adult patients with acute myelogenous leukemia after induction chemotherapy

Dionissios Neofytos, Kit Lu, Amy Hatfield-Seung, Amanda Blackford, Kieren A. Marr, Suzanne Treadway, Darin Ostrander, Veronique Nussenblatt, Judith Karp

Research output: Contribution to journalArticle

Abstract

This is a retrospective, single-center study of adult patients with newly diagnosed acute myelogenous leukemia (AML), who received intensive induction timed sequential chemotherapy from 1/2005 to 6/2010. Among 254 consecutive AML patients, 123 (48.4%) developed an invasive fungal infection (IFI): 14 (5.5%) patients with invasive candidiasis (IC) and 108 (42.5%) patients with invasive mould infections (IMI). Among 108 IMI identified, 4 (3.7%) were proven, 1 (0.9%) probable, and 103 (95.4%) were possible, using current definitions. Overall, 6-month mortality was 23.7% (27/114) and 20.6% (26/126) for patients with and without an IFI, respectively. Older age (≥50 years; hazard ratio [HR]: 2.5, P < 0.001), female gender (HR: 1.7, P = 0.006), and baseline renal and/or liver dysfunction (HR: 2.4, P < 0.001) were the strongest mortality predictors. We report relatively low rates of IC despite lack of routine primary antifungal prophylaxis, albeit associated with poor long-term survival. High rates of IMI, the vast majority with a possible diagnosis, were observed. Host-related variables (demographics and baseline organ dysfunction) were identified as the most significant risk factors for IFI and mortality predictors in this series.

Original languageEnglish (US)
Pages (from-to)144-149
Number of pages6
JournalDiagnostic Microbiology and Infectious Disease
Volume75
Issue number2
DOIs
StatePublished - Feb 1 2013

Keywords

  • Acute myeloid leukemia
  • Epidemiology
  • Invasive fungal infections
  • Risk factors
  • Survival

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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