Retrospective study of antimicrobial prophylaxis and infections in patients with acute myeloid leukemia
Jeffrey Jang1, Timothy Nold1, Joseph P Marshalek2
1Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA.
Abstract:
Introduction: Patients with acute myeloid leukemia (AML) are immunocompromised as a result of their malignancy and treatment, which can predispose to infection. The incidence of bacterial infection is most common (75-80%), followed by fungal (7-33%) and viral (12-20%) infections. Prophylaxis is recommended; however, uncertainty exists regarding optimal agent and duration. Methods: We present a single-center retrospective experience of 63 patients with AML from 2014-2024 investigating prophylaxis, infections, risk factors, and survival. Results: Median age was 53 years old, and the most common induction therapies were 7 + 3 (63%), azacitidine (11%), azacitidine + venetoclax (6%), and 7 + 3 + midostaurin (6%). Prophylaxis against fungal, viral, and bacterial infections was used in 87%, 75%, and 11% of patients. Across all lines of therapy, fungal, viral, and bacterial infections were diagnosed in 22%, 19%, and 78% of patients. Antiviral prophylaxis was associated with a statistically significant reduction in viral infections (13% vs. 38%, p = 0.029) with no significant impact on overall survival (HR 0.85, 95% CI 0.32-2.26, p = 0.731). Antifungal and antibacterial prophylaxis were not associated with a decreased risk of infection nor improved survival. The rate of fungal infection was higher in patients with adverse risk AML compared to intermediate or favorable risk (41% vs. 15%, p = 0.028). Conclusion: This study provides valuable insight regarding prophylaxis and infections in AML patients, demonstrating the benefit of antiviral prophylaxis in reducing viral infections and the substantial risk of bacterial infection throughout all phases of treatment.
Insights
Patients with acute myeloid leukemia (AML) are at high risk for infections. Antiviral prophylaxis effectively reduces viral infections in AML patients, but antifungal and antibacterial prophylaxis showed no significant benefit.
Area of Science:
- Hematology
- Infectious Diseases
- Oncology
Background:
- Patients with acute myeloid leukemia (AML) experience compromised immunity due to malignancy and treatment.
- Bacterial infections are most common (75-80%) in AML patients, followed by viral (12-20%) and fungal (7-33%) infections.
- Optimal prophylaxis strategies for infections in AML patients remain uncertain.
Purpose of the Study:
- To investigate the incidence of infections and the impact of prophylaxis in patients with acute myeloid leukemia (AML).
- To identify risk factors for infections and assess their effect on survival in AML patients.
- To evaluate the effectiveness of antiviral, antifungal, and antibacterial prophylaxis in reducing infection rates and improving survival.
Main Methods:
- A single-center retrospective study of 63 AML patients from 2014-2024.
- Data collected on patient demographics, induction therapies, prophylaxis use, infection types, and survival outcomes.
- Statistical analysis to determine the association between prophylaxis and infection rates, and risk factors for infection.
Main Results:
- Antiviral prophylaxis was associated with a significant reduction in viral infections (13% vs. 38%, p=0.029).
- Antifungal and antibacterial prophylaxis did not demonstrate a decreased risk of infection or improved survival.
- Patients with adverse-risk AML had a higher rate of fungal infections compared to intermediate or favorable-risk patients (41% vs. 15%, p=0.028).
Conclusions:
- Antiviral prophylaxis is beneficial in reducing viral infections in acute myeloid leukemia patients.
- Antifungal and antibacterial prophylaxis strategies require further investigation for efficacy in AML.
- Bacterial infections pose a substantial risk throughout all phases of AML treatment.
