Invasive aspergillosis: an important risk factor on the short- and long-term survival of acute myeloid leukemia (AML) patients

Abstract

Invasive aspergillosis (IA) during induction chemotherapy of acute myeloid leukemia (AML) could worsen the prognosis. Our objective was to study how the development of IA during AML interferes with the therapeutic strategy and to evaluate its impact on the short- and long-term survival. Newly diagnosed AML patients between the years 2004 and 2007 were retrospectively analyzed. The outcome was death of the patient. A Cox proportional hazards model with the diagnosis of IA and post-induction response evaluation as the main exposure was fitted. Overall, 262 patients were analyzed and 58 IA were observed. The 2-year survival of patients having had remission of AML was 54% and, for patients with failure of chemotherapy, it was 5% (p < 0.001). The 2-year survival of patients having had IA was 14%, and without IA, it was 32% (p = 0.01). Multivariate analysis showed that IA was associated with a higher risk of death in case of remission compared to no IA (hazard ratio [HR] = 1.66 [1.05-2.65], p = 0.031) and also in case of failure (HR = 6.43, p < 0.001). IA was associated with an increased risk of death for patients if they were either in remission or in failure after induction chemotherapy.

A Single Center Experience for Antifungal Prophylaxis in Patients with Acute Myelogenous Leukemia

“…Antibacterial prophylaxis consisted of levofloxacin 500 mg daily or moxifloxacin 400 mg daily. Patients (2) receipt of any other systemic antifungal agent for 4 days or more during febrile neutropenia episode without any identified IFDs, (3) the occurrence of an adverse event related to the fluconazole or posaconazole resulting in the discontinuation of antifungal prophylaxis. According to EORTC/MSG criteria; possible pulmonary fungal disease was defined as persistent neutropenia plus radiological findings (dense, wellcircumscribed nodular lesion(s) with or without a halo sign, air-crescent sign, and cavitary lesion) concordant with IFDs without microbiological evidence.…”

“…Fluconazole prophylaxis (FP) was used to prevent IFDs for a long time, however, the increasing rate of fluconazole resistant Candida spp. and lack of activity against Aspergillus species cause concern about the effectivity of FP [1,2]. Posaconazole is a new azole agent which provides broad-spectrum coverage against several yeasts and moulds, including fluconazole-resistant Candida spp.…”

An Invisible Threat: Mutation-Mediated Resistance to Triazole Drugs in Aspergillus

“…These three groups have the highest risk of developing IA, and outcome is particularly poor for those with acute myeloid leukemia (AML) where IA is commonly diagnosed within the first 100 days post-onset immunosuppressive therapy [25]. In one study, between 2004 and 2007 22% of 262 AML patients developed IA and 86% of these IA cases died within two years [26]. A large scale surveillance study in Italian hospitals estimated that more than 2.6% of 3228 HSCT patients had IA as an infectious complication [27].…”

Prognostic Factors, Survival Analysis and Cytogenetic Outcomes in Adult Patients with Acute Myeloid Leukemia: A single Center Results

“…Mortality rate was significantly higher in the group with invasive fungal pneumonia. 6 In the study by Tang et al, IFI incidence was 34.6% at the stage of induction chemotherapy. Presence of IFI at the time of induction is considered as an independent predictor of poor survival.…”

“…After the induction chemotherapy, regardless of the patients remission status, presence of IA increases the risk of mortality. 6 The aim of our study is to detect the clinical and laboratory characteristics of our AML patients as well as the factors that affect the prognosis, to compare the results with the existing literature and to identify any regional differences.…”