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.
M. Culler Freeman, None
L. Thomas, None
G. Satyanarayana, None
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