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High incidence of invasive fungal infection during acute myeloid leukemia treatment in a resource-limited country: clinical risk factors and treatment outcomes

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A Correction to this article was published on 18 June 2019

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Abstract

Background

Invasive fungal infection (IFI) causes high morbidity and mortality during acute myeloid leukemia (AML) treatment. Interventions to prevent fungal infection, including air filtration systems and antifungal prophylaxis, may improve outcomes in this group of patients. However, they are expensive and therefore inapplicable in resource-limited countries. The benefit of antifungal therapy is also dependent on the local epidemiology. That led us to conduct the study to evaluate the characteristics and impact of IFI in AML patients without prophylaxis in our setting.

Methods

Clinical data from patients with AML who have been treated with chemotherapy without antifungal prophylaxis were retrieved during a 5-year period at Thailand’s hematology referral center. Incidence and risk factors of IFI and outcomes of patients were evaluated.

Results

Among 292 chemotherapy courses, there were 65 (22.3%) episodes of IFI. Of those, 10 (15.4%) were proven, 19 (29.2%) were probable, and 36 (55.4%) were categorized as being possible IFI. Molds were the most commonly observed causative pathogens (93.1%). The incidence of probable/proven IFI was highest during first induction (20.5%), followed by second induction (6.1%), and consolidation (2.7%). A long duration of neutropenia, old age, and low serum albumin were the strongest predictors of IFI. Compared with patients who had no IFI, patients with probable/proven IFI had a longer length of hospital stay and higher in-hospital mortality. Patients with proven IFI had a significantly worse outcome at 1 year.

Conclusions

These results suggest the change in health policy to implement IFI preventive measures to improve outcomes of AML treatment.

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Change history

  • 18 June 2019

    Incorrect family name of Warissara Jutidamrongphan.

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Funding

This research was supported by Siriraj Cancer Foundation (Grant number 088/2558). None of the authors has financial relationship with the foundation.

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Author notes

  1. Variya Nganthavee and Woraphun Phutthasakda contributed equally to this work.

Authors and Affiliations

  1. Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Variya Nganthavee, Woraphun Phutthasakda, Kawita Atipas, Sirikul Tanpong, Teeramet Pungprasert, Dhanach Dhirachaikulpanich, Saran Krithin, Supang Tanglitanon & Warissara Jutidamronphang

  2. Division of Hematology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok, 10700, Thailand

    Weerapat Owattanapanich & Ployploen Phikulsod

  3. Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Methee Chayakulkeeree

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  1. Variya Nganthavee
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Corresponding author

Correspondence to Ployploen Phikulsod.

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All authors declare no personal or professional conflicts of interest and no financial support from the companies that produce and/or distribute the drugs, devices, or materials described in this report. The protocol for this study was approved by the Siriraj Institutional Review Board (SIRB) of the Faculty of Medicine Siriraj Hospital, Mahidol University (COA no. 212/2016). The requirement for written informed consent was waived for this study due to its anonymous retrospective design.

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Nganthavee, V., Phutthasakda, W., Atipas, K. et al. High incidence of invasive fungal infection during acute myeloid leukemia treatment in a resource-limited country: clinical risk factors and treatment outcomes. Support Care Cancer 27, 3613–3622 (2019). https://doi.org/10.1007/s00520-019-04720-5

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