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Invasive Fungal Infections in Patients with Acute Myeloid Leukemia Undergoing Intensive Chemotherapy

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Indian Journal of Hematology and Blood Transfusion Aims and scope Submit manuscript

Abstract

Patients with hematological malignancies are severely immunocompromised and are at high risk of invasive fungal infection (IFI), particularly those undergoing remission-induction chemotherapy for acute myeloid leukemia (AML). IFIs are a major cause of morbidity and mortality in such patients. We planned to study the incidence of IFI in patients with AML undergoing intensive chemotherapy and receiving antifungal prophylaxis. We retrospectively reviewed consecutive 46 patients with non-M3 AML, who received induction chemotherapy and systemic antifungal prophylaxis. None of the patients had IFI at the time of initiation of the chemotherapy. Patients were monitored for the occurrence of IFI using high-resolution computerized tomography of the chest or para-nasal sinus and test for galactomannan antigen on serum or broncho-alveolar lavage and were followed up for 90 days. Of the 46 patients on intensive chemotherapies, 41, 4 and 1 patients were started on posaconazole, amphotericin B and voriconazole prophylaxis, respectively. The occurrence of possible and probable IFI was observed in 16 and 4 patients respectively, in which 19 patients were on posaconazole and 1 patient was on amphotericin-B prophylaxis. Overall mortality in the study population was 11 (23.9%). Four out of 20 patients died with IFI but none of the death was attributable to IFI. IFI still remains a significant cause of morbidity and mortality in patients with AML despite universal use of antifungal prophylaxis. With effective pharmacotherapy, the mortality due to IFI is preventable. Appropriate antifungal prophylaxis strategy still needs to be developed through larger and prospective studies.

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Abbreviations

AML:

Acute myeloid leukemia

AFP:

Antifungal prophylaxis

IFI:

Invasive fungal infection

EORTC:

European Organization for Research and Treatment of Cancer and the Mycoses Study Group

CT:

Computed tomography

BAL:

Bronchoalveolar lavage

HAM:

High dose cytarabine and mitoxantrone

HiDAC:

High dose cytarabine

GM:

Galactomannan

HRCT:

High-resolution computerized tomography

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Authors and Affiliations

  1. Centre for Translational and Clinical Research, School of Chemical and Life Sciences, Jamia Hamdard, New Delhi, 110062, India

    Pinki Mishra & Nidhi Bharal Agarwal

  2. Department of Hemato-Oncology and Bone Marrow Transplant, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, New Delhi, India

    Narendra Agrawal & Dinesh Bhurani

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  1. Pinki Mishra
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  2. Narendra Agrawal
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  3. Dinesh Bhurani
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  4. Nidhi Bharal Agarwal
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Correspondence to Nidhi Bharal Agarwal.

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Mishra, P., Agrawal, N., Bhurani, D. et al. Invasive Fungal Infections in Patients with Acute Myeloid Leukemia Undergoing Intensive Chemotherapy. Indian J Hematol Blood Transfus 36, 64–70 (2020). https://doi.org/10.1007/s12288-019-01165-y

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  • DOI: https://doi.org/10.1007/s12288-019-01165-y

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