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Breakthrough Invasive Fungal Infections in Patients with Acute Myeloid Leukemia
Anastasia Wasylyshyn1, Kathleen A Linder1,2, Caroline G Castillo1
1Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Objectives:
We sought to determine the occurrence, risk factors, effect of antifungal prophylaxis, and outcomes of invasive fungal infections (IFIs) in patients with acute myeloid leukemia (AML).
Patients And Methods:
We performed a retrospective analysis of all adult patients admitted to the University of Michigan Health System for AML over a 3-year period from 2010 to 2013. We determined comorbidities, hematopoietic cell transplant (HCT) status, antifungal prophylaxis, proven and probable IFI, and outcomes at 12 weeks after initiation of appropriate antifungal therapy.
Results:
Of 333 patients in our cohort, 116 of whom had received a HCT, 98 (29%) developed an IFI. Of the 30 (9%) patients who had a proven or probable IFI, 18 had breakthrough infection while on micafungin (n = 5), voriconazole (n = 4), posaconazole (n = 5), or fluconazole (n = 4). Breakthrough IFIs were due to Aspergillus species (n = 11), other molds (n = 4), and Candida species (n = 3). Factors associated with breakthrough IFI were prolonged severe neutropenia (p = .05) and having received tacrolimus (p = .04). Antifungal therapy was successful in 7 of the 18 (39%) patients with breakthrough IFI and 8 of the 12 (67%) patients with non-breakthrough IFI, p = .13. Mortality at 12 weeks was 27%, 5 with breakthrough IFI and 3 with non-breakthrough IFI and was associated with prolonged severe neutropenia, p = .04.
Conclusions:
Patients with AML remain at risk for IFI despite the use of several different antifungal agents for prophylaxis. Mortality remains high in patients with AML who develop IFI.
Insights
Invasive fungal infections (IFIs) affect 29% of acute myeloid leukemia (AML) patients, with breakthrough infections occurring even with antifungal prophylaxis. Mortality remains high for AML patients with IFIs.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Acute myeloid leukemia (AML) patients are immunocompromised and susceptible to invasive fungal infections (IFIs).
- Antifungal prophylaxis is commonly used, but breakthrough IFIs still occur.
- Understanding risk factors and outcomes is crucial for improving patient management.
Purpose of the Study:
- To determine the incidence, risk factors, and outcomes of IFIs in adult AML patients.
- To evaluate the effectiveness of antifungal prophylaxis in preventing IFIs.
- To identify factors associated with breakthrough IFIs and mortality.
Main Methods:
- Retrospective analysis of 333 adult AML patients admitted between 2010 and 2013.
- Data collected included comorbidities, hematopoietic cell transplant (HCT) status, antifungal prophylaxis, and IFI occurrence.
- Outcomes assessed included response to antifungal therapy and 12-week mortality.
Main Results:
- 29% of AML patients developed an IFI; 9% had proven or probable IFIs.
- 18 breakthrough IFIs occurred despite prophylaxis with various antifungal agents.
- Prolonged severe neutropenia and tacrolimus use were associated with breakthrough IFIs. 12-week mortality was 27%.
Conclusions:
- AML patients remain at significant risk for IFIs, even with antifungal prophylaxis.
- Breakthrough IFIs and high mortality rates underscore the challenges in managing these infections.
- Further strategies are needed to reduce IFI incidence and improve outcomes in AML patients.
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