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Invasive Fungal Disease Associated With Targeted Agents for Acute Myeloid Leukaemia: A Systematic Review
Samir Agrawal1,2, Anjaneya Bapat3, Christopher P Eades4,5
1Queen Mary University of London London UK.
Objective:
To examine the incidence of invasive fungal disease (IFD) in patients receiving targeted agents for acute myeloid leukaemia (AML).
Methods:
Literature for this systematic review was identified through a PubMed search in April 2024, using AML, IFD and targeted therapy terms. The following filters were applied: published in the last 10 years and published in English.
Results:
The PubMed search yielded 54 results, of which 16 were deemed relevant for inclusion. Four additional references were identified through manual searches. The majority of publications focused on the incidence of IFD during treatment with targeted agents; the remainder focused on the efficacy of targeted treatments and reported IFD as an adverse event. Most publications were retrospective analyses. Prophylaxis use and agents differed across studies. In several studies, IFD incidence was above the 8% threshold identified for anti-mould prophylaxis. Aspergillus was the most commonly reported pathogen, and most IFD cases occurred in the lungs.
Conclusions:
IFD is relatively common among patients with AML receiving targeted therapies, despite the use of prophylaxis. Prospective studies with detailed IFD reporting, together with large epidemiological studies, are required to better understand the risk factors for, and incidence and nature of IFD in this patient population.
Insights
Invasive fungal disease (IFD) is common in acute myeloid leukaemia (AML) patients on targeted therapy. Incidence rates in several studies exceeded prophylaxis thresholds, highlighting a significant clinical concern.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Targeted therapies are increasingly used in acute myeloid leukaemia (AML) treatment.
- The risk of invasive fungal disease (IFD) in this patient population requires careful evaluation.
Purpose of the Study:
- To systematically review the incidence of invasive fungal disease (IFD) in patients with acute myeloid leukaemia (AML) undergoing treatment with targeted agents.
Main Methods:
- A systematic literature search was conducted on PubMed in April 2024, focusing on AML, IFD, and targeted therapy.
- Inclusion criteria included studies published in English within the last 10 years.
- Relevant studies were supplemented with manual reference searches.
Main Results:
- 16 relevant publications were identified from 54 initial search results, with four additional studies found manually.
- The majority of studies reported IFD incidence during targeted agent treatment, with some noting IFD as an adverse event.
- Several studies reported IFD incidence exceeding the 8% threshold for anti-mould prophylaxis, with *Aspergillus* being the most common pathogen, primarily affecting the lungs.
Conclusions:
- Invasive fungal disease (IFD) is a frequent complication in AML patients receiving targeted therapies, even with prophylaxis.
- Further prospective and large-scale epidemiological studies are needed to fully elucidate IFD risk factors, incidence, and characteristics in this vulnerable group.
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