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Invasive Mold Infections in FLT3-Mutated Acute Myeloid Leukemia
Pakpoom Phoompoung1, Benoît Henry2, Georgina Daher-Reyes3
1Transplant Infectious Diseases, Ajmera Transplant Centre; Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Background:
The incidence and risk factors for invasive mold infections (IMI) in acute myeloid leukemia (AML) patients carrying FLT3 mutations have not been addressed.
Patients And Methods:
This retrospective cohort included FLT3-mutated AML patients (2008-2018). Primary outcome was IMI incidence within 6 months after first induction or salvage therapy.
Results:
We included 108 patients receiving fluconazole or micafungin prophylaxis. IMI incidence after induction and salvage therapy was 4.8% and 14.8%, respectively, and did not differ between patients receiving 3+7 regimen or 3+7 plus midostaurin (4.3% vs 4.5%). In a bivariate analysis, age (odds ratio, 1.11; P = .027) and FLT3 ITD mutation (odds ratio, 0.05; P = .023) were independently associated with IMI after induction chemotherapy. Gilteritinib was more frequently prescribed in patients with relapsed/refractory disease who developed IMI (50% vs 27.3%, P = .563).
Conclusion:
FLT3 ITD mutation may be a preventive factor for IMI. Neither midostaurin nor salvage gilteritinib significantly increased the risk of IMI in this population.
Insights
Invasive mold infections (IMI) are a concern in acute myeloid leukemia (AML). FLT3 ITD mutations may protect against IMI, while midostaurin and gilteritinib did not increase risk in AML patients.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Invasive mold infections (IMI) pose a significant risk to acute myeloid leukemia (AML) patients.
- Risk factors for IMI in AML patients with FLT3 mutations remain understudied.
Purpose of the Study:
- To investigate the incidence and risk factors of IMI in FLT3-mutated AML patients.
- To evaluate the impact of specific therapies on IMI risk in this cohort.
Main Methods:
- Retrospective cohort study of 108 FLT3-mutated AML patients (2008-2018).
- Assessed IMI incidence within 6 months of induction or salvage therapy.
- Analyzed association of age, FLT3 mutations, and treatments (midostaurin, gilteritinib) with IMI.
Main Results:
- Overall IMI incidence was 4.8% after induction and 14.8% after salvage therapy.
- FLT3 ITD mutation was independently associated with a lower risk of IMI (OR, 0.05; P=.023).
- Midostaurin and gilteritinib did not significantly increase IMI risk.
Conclusions:
- FLT3 ITD mutation may confer a protective effect against IMI in AML.
- Targeted therapies like midostaurin and gilteritinib appear safe regarding IMI risk in this patient population.
