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A Prospective Observational Multi-institutional Study on Invasive Fungal Infections Following Chemotherapy for Acute Myeloid Leukemia (MISFIC Study): A Real World Scenario from India

  • Biju GeorgeEmail author
  • Hari Menon
  • Dinesh Bhurani
  • Sharat Damodar
  • Shashi Apte
  • Tulika Seth
  • Ajay Sharma
  • Radhe Shyam
  • Pankaj Malhotra
  • Jose Easow
  • Kavitha M. Lakshmi
  • Narendra Agrawal
  • Manju Sengar
  • KS Nataraj
  • Rayaz Ahmed
  • Sanjeevan Sharma
  • Alka Khadwal
  • Gaurav Prakash
  • Aby Abraham
  • Anup Devasia
  • Anu Korula
  • Vikram Mathews
Original Article
  • 21 Downloads

Abstract

We performed a prospective multi-centre observational study to understand the incidence of IFI in patients with AML in India with use of anti-fungal prophylaxis. All patients with AML receiving either induction chemotherapy or salvage chemotherapy between November 2014 and February 2016 were included in this prospective observational study from 10 Indian centres. IFI was defined as per the revised EORTC-MSG criteria. Data on type of chemotherapy used, type of anti-fungal prophylaxis used, time to neutrophil recovery, incidence of IFI and survival were collected. Two hundred patients (118 male and 82 females) with a median age of 35 years (range: 2–66) were recruited. One hundred and eighty-six (93%) had newly diagnosed acute myeloid leukemia (AML) while 14 (7%) had relapsed disease. IFI occurred in 53 patients (26.5%) with proven or probable IFI occurring in 17 (8.5%). Use of posaconazole prophylaxis (p = 0.027) was the only factor found to be associated with a reduced incidence of IFI. The overall survival (OS) at 6 weeks and 3 months respectively was similar among patients who had IFI (83.0 ± 5.2%; 81.0 ± 5.4%) as compared to those without IFI (84.4 + 3.0%; 81.4 ± 3.2%). This prospective study reveals a high incidence of IFI in patients undergoing chemotherapy for AML in India. The use of posaconazole prophylaxis was associated with a significantly lower incidence of IFI. Optimal strategies to prevent IFI need to be studied.

Keywords

Fungal infection Incidence AML India 

Notes

Acknowledgements

This study was funded through an education grant from Merck, Sharpe and Dome (MSD).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Human and Animal Participants

All research involving human participants was performed as per the guidelines established by the Helsinki declaration. All participating institutions obtained ethical clearance from their respective institutions before starting the trial.

Informed Consents

All subjects were included only after signing an informed consent.

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Copyright information

© Indian Society of Hematology and Blood Transfusion 2019

Authors and Affiliations

  • Biju George
    • 1
    Email author
  • Hari Menon
    • 2
  • Dinesh Bhurani
    • 3
  • Sharat Damodar
    • 4
  • Shashi Apte
    • 5
  • Tulika Seth
    • 6
  • Ajay Sharma
    • 7
  • Radhe Shyam
    • 8
  • Pankaj Malhotra
    • 9
  • Jose Easow
    • 10
  • Kavitha M. Lakshmi
    • 1
  • Narendra Agrawal
    • 3
  • Manju Sengar
    • 2
  • KS Nataraj
    • 4
  • Rayaz Ahmed
    • 3
  • Sanjeevan Sharma
    • 7
  • Alka Khadwal
    • 9
  • Gaurav Prakash
    • 9
  • Aby Abraham
    • 1
  • Anup Devasia
    • 1
  • Anu Korula
    • 1
  • Vikram Mathews
    • 1
  1. 1.Christian Medical CollegeVelloreIndia
  2. 2.Tata Memorial HospitalMumbaiIndia
  3. 3.Rajiv Gandhi Cancer InstituteNew DelhiIndia
  4. 4.Narayana HirudalayaBengaluruIndia
  5. 5.Sahayadri HospitalPuneIndia
  6. 6.All India Institute of Medical SciencesNew DelhiIndia
  7. 7.R and R HospitalNew DelhiIndia
  8. 8.HCG HospitalBengaluruIndia
  9. 9.Post Graduate Institute of Medical Education and Research (PGIMER)ChandigarhIndia
  10. 10.Apollo Specialty HospitalChennaiIndia

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