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Invasive Fusariosis Among Patients with Acute Leukemia: A 12-Year Single-Center Experience in a Middle-Income Country
Raquel Keiko de Luca Ito1, Patricia Rodrigues Bonazzi Pontes2, Adriana Satie Goncalves Kono Magri2
1São Paulo State Cancer Institute (ICESP), University of São Paulo School of Medicine, São Paulo, Brazil. raquel.ito@hc.fm.usp.br.
Introduction:
Invasive fusariosis (IF) is one of the most aggressive mold infections in patients with acute leukemia, characterized by rapid dissemination, high rates of fungemia, and limited antifungal susceptibility. Its impact is particularly severe in middle-income countries, yet single-center data from these settings remain scarce.
Materials And Methods:
We conducted a retrospective study of all patients with acute leukemia and proven IF, diagnosed according to EORTC/MSG criteria, from January 2011 to August 2023. Demographic, clinical, therapeutic, and outcome variables were analyzed.
Results:
Twenty-six patients were identified. Median age was 46.5 years, and 53.8% were female. Acute myeloid leukemia was the most frequent underlying condition. All patients presented with severe neutropenia at diagnosis. Disseminated disease occurred in 84.6% of cases; two patients had isolated fungemia and two had localized skin disease. Cutaneous lesions were present in 73% of patients, and 31% had pulmonary involvement. Antifungal prophylaxis, mainly fluconazole or anidulafungin, was used in 69.2% of cases. Treatment consisted of lipid formulations of amphotericin B, either alone or combined with voriconazole. Thirty-day mortality reached 38.5%. Mortality was significantly higher among patients undergoing re-induction therapy, whereas those who had received antifungal prophylaxis exhibited lower mortality.
Discussion:
IF in acute leukemia was associated with extensive dissemination and substantial early mortality. Mortality rates were higher in patients in re-induction therapy and lower in those who received antifungal prophylaxis. The role of combination antifungal therapy requires further investigation.
Insights
Invasive fusariosis (IF) in acute leukemia patients leads to widespread infection and high mortality. Antifungal prophylaxis reduced deaths, while re-induction therapy increased them.
Area of Science:
- Mycology
- Hematology
- Infectious Diseases
Background:
- Invasive fusariosis (IF) is a severe mold infection in acute leukemia patients.
- IF presents with rapid spread, fungemia, and drug resistance, especially in middle-income countries.
Purpose of the Study:
- To analyze clinical characteristics, treatment, and outcomes of IF in acute leukemia patients.
- To identify factors influencing mortality in IF.
Main Methods:
- Retrospective study of acute leukemia patients with proven IF (January 2011 - August 2023).
- Analysis of demographic, clinical, therapeutic, and outcome data.
- Diagnosis confirmed by EORTC/MSG criteria.
Main Results:
- 26 patients identified; median age 46.5 years, 53.8% female.
- 84.6% had disseminated disease; 73% had cutaneous lesions, 31% pulmonary involvement.
- 30-day mortality was 38.5%; prophylaxis lowered mortality, re-induction therapy increased it.
Conclusions:
- IF in acute leukemia is linked to extensive dissemination and high early mortality.
- Antifungal prophylaxis is associated with reduced mortality.
- Further research is needed on combination antifungal therapy efficacy.
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