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Incidence of Invasive Fungal Infections in Patients With Previously Untreated Acute Myeloid Leukemia Receiving
Alexander Zhang1, Tanner Johnson2, Diana Abbott3
1School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA.
Background:
Acute myeloid leukemia (AML) is associated with poor prognosis, particularly in elderly patients with comorbidities. Combining azacitidine (AZA) with BCL-2 inhibitor venetoclax (VEN) demonstrated significant improvement in outcomes for newly-diagnosed AML patients compared to AZA alone. However, this regimen is myelosuppressive, and the incidence of invasive fungal infections (IFIs) and impact of antifungal prophylaxis are not well defined.
Methods:
This retrospective cohort study evaluated newly-diagnosed AML patients treated with VEN/AZA at the University of Colorado Hospital from January 2014 to August 2020. Patients with history of prior IFI were excluded. Primary outcome was IFI incidence during VEN/AZA therapy. χ2 and Fisher exact tests assessed the impact of patient demographics, AML-specific risk factors, and receipt of antifungal prophylaxis on IFI incidence.
Results:
144 VEN/AZA-treated AML patients were included in the study. 25 (17%) patients developed IFI: 8% (n = 2) "proven," 24% (n = 6) "probable," and 68% (n = 17) "possible" per European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium criteria. There was no statistically significant association between IFI incidence with age, sex, or European LeukemiaNet classification. 10 patients received antifungal prophylaxis; none developed IFI. IFI incidence rate per 1000 patient-days was greatest 0-9 days after starting VEN/AZA, at 8.39.
Conclusions:
Incidence of "proven" and "probable" IFI in our VEN/AZA-treated AML cohort was 5.6%, in-line with incidence rates reported by recent similar studies. Furthermore, IFI incidence decreased as days from starting VEN/AZA therapy increased.
Insights
The combination of venetoclax (VEN) and azacitidine (AZA) for acute myeloid leukemia (AML) shows a 5.6% incidence of proven or probable invasive fungal infections (IFIs). Antifungal prophylaxis may reduce IFI risk in AML patients receiving VEN/AZA therapy.
Area of Science:
- Hematology
- Oncology
- Infectious Diseases
Background:
- Acute myeloid leukemia (AML) often has a poor prognosis, especially in older adults.
- The combination of azacitidine (AZA) and venetoclax (VEN) improves outcomes for newly-diagnosed AML patients.
- This regimen is myelosuppressive, increasing the risk of invasive fungal infections (IFIs).
Purpose of the Study:
- To evaluate the incidence of IFIs in newly-diagnosed AML patients treated with VEN/AZA.
- To assess the impact of antifungal prophylaxis on IFI incidence in this patient group.
Main Methods:
- Retrospective cohort study of 144 AML patients treated with VEN/AZA.
- Exclusion of patients with a history of prior IFI.
- Analysis of IFI incidence and correlation with patient demographics, risk factors, and antifungal prophylaxis.
Main Results:
- 17% of patients developed IFIs (8% proven, 24% probable, 68% possible).
- No significant association between IFI incidence and age, sex, or European LeukemiaNet classification.
- 10 patients received antifungal prophylaxis, and none developed IFIs. IFI incidence was highest within the first 9 days of VEN/AZA therapy.
Conclusions:
- The incidence of proven and probable IFIs was 5.6% in the VEN/AZA-treated AML cohort.
- IFI incidence decreased with increasing time from VEN/AZA therapy initiation.
- Antifungal prophylaxis may be beneficial in reducing IFI risk for AML patients on VEN/AZA.
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