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Breakthrough Fungal Infections in Patients With Leukemia Receiving Isavuconazole

Caitlin R Rausch1, Adam J DiPippo1, Prithviraj Bose2

  • 1Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|May 18, 2018
PubMed

Insights

Breakthrough invasive fungal infections occurred in 13% of leukemia patients on isavuconazole. These infections were linked to prolonged neutropenia and active leukemia, highlighting key risk factors.

Area of Science:

  • Mycology
  • Hematology
  • Infectious Diseases

Background:

  • Invasive fungal infections (IFIs) are a significant cause of morbidity and mortality in immunocompromised patients, particularly those with hematologic malignancies.
  • Leukemia patients are at high risk for IFIs due to prolonged neutropenia and disease-related immune dysfunction.
  • Isavuconazole is a broad-spectrum triazole antifungal agent used for treating IFIs.

Purpose of the Study:

  • To retrospectively assess the incidence and characteristics of breakthrough invasive fungal infections (b-IFIs) in leukemia patients treated with single-agent isavuconazole.

Main Methods:

  • Retrospective analysis of 100 consecutive leukemia patients receiving single-agent isavuconazole.
  • Documentation and classification of breakthrough invasive fungal infections, including candidiasis and mucormycosis.

Main Results:

  • Thirteen out of 100 patients (13%) experienced documented b-IFIs.
  • The most common b-IFIs were candidiasis (6 cases) and mucormycosis (4 cases).
  • All b-IFIs occurred in patients with prolonged neutropenia and active leukemia.

Conclusions:

  • Single-agent isavuconazole may be associated with breakthrough invasive fungal infections in leukemia patients.
  • Prolonged neutropenia and active leukemia are critical risk factors for developing b-IFIs even with azole antifungal therapy.
  • Further prospective studies are warranted to evaluate the efficacy and safety of isavuconazole in this high-risk population.

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