1581. Invasive Fungal Disease in Acute Leukemia: Single Center Retrospective Study
Session: Poster Abstract Session: Mycology - There's a Fungus Among Us: Epidemiology
Friday, October 28, 2016
Room: Poster Hall
  • IDSA_1581_IFDacuteleukemia.png (913.9 kB)
  • Background: Invasive fungal disease (IFD) is a leading cause of morbidity and mortality in patients undergoing treatment for acute leukemia. Guidelines from the National Comprehensive Cancer Network and Infectious Diseases Society of America recommend routine prophylactic antifungal therapy in patients who become neutropenic while undergoing chemotherapy treatment for acute leukemia. The purpose of this study was to determine the incidence of IFD in patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) receiving chemotherapy at Vanderbilt University Medical Center (VUMC).

    Methods: This was a retrospective study examining adult patients with AML or ALL admitted to VUMC between July 1, 2012 and June 30, 2014 for chemotherapy treatment. The diagnosis of IFD was classified as proven or probable based on definitions from the 2008 European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Patients who received all chemotherapy prior to July 1, 2012 or at another facility were excluded from the study.

    Results: A total of 223 patients who underwent 717 chemotherapy sessions were included in the study. Patients received antifungal prophylaxis during 74% of the chemotherapy sessions, and 84% of those patients received fluconazole. There was a 9% incidence of IFD, 77% proven and 23% probable cases. Ninety percent of IFD occurred in AML patients, with induction chemotherapy placing patients at higher risk (p = 0.001). Aspergillus was the leading cause of IFD, followed by Zygomycetes. The mean duration of neutropenia prior to IFD diagnosis was 17 days. CLAG-M chemotherapy (p < 0.001), mucositis (p = 0.001), and a low baseline absolute neutrophil count (p = 0.004) were additional risk factors for IFD. The risk of developing IFD within 1 year of chemotherapy was 11% (95% CI, 7-17%).

    Conclusion: The rates of IFD in this cohort are consistent with reported rates at similar institutions which use fluconazole for prophylaxis or use no antifungal prophylaxis. Targeted antifungal prophylaxis with activity against Aspergillus species may be useful in a select group of high-risk AML patients.

    James England, M.D.1, Sahar Torabi, Pharm.D.1,2, Megan Culler Freeman, M.D., Ph.D.1, Lora Thomas, M.D., M.P.H.1 and Gowri Satyanarayana, M.D.1, (1)Vanderbilt University Medical Center, Nashville, TN, (2)Lipscomb University College of Pharmacy, Nashville, TN


    J. England, None

    S. Torabi, None

    M. Culler Freeman, None

    L. Thomas, None

    G. Satyanarayana, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.