Methods: Single-center retrospective cohort analysis of all adult patients admitted to the University of Michigan for AL from 1/1/2010-12/31/2013. Chart review determined co-morbidities, chemotherapy regimens, antifungal prophylaxis, occurrence of IFI as determined by EORTC/MSG criteria, and outcomes. Chi-square, Fischer’s, ANOVA, and binary logistic regression tests were performed when appropriate.
Results: Of 363 patients, all but 4 had acute myeloid leukemia (AML); 124 had a stem cell transplant (SCT). A total of 103 (28%) had proven (n=13), probable (n=22), or possible (n=68) IFI. Considering only those 35 patients who had proven or probable IFI, the only risk factor for development of IFI by logistic regression analysis was IFLAG chemotherapy (p=.006). Mold infections occurred in 27 patients: Aspergillus (19), Mucorales (5), both Aspergillus and Mucorales (1), Alternaria (1), & Scedosporium (1). Additionally, 5 patients had invasive candidiasis & 3 had Pneumocystis. 18 of 35 patients (51%) had breakthrough IFI while on posaconazole suspension (6), fluconazole (5), micafungin (5) or voriconazole (2). Factors significantly associated with breakthrough IFI were SCT (p=.04), neutrophils <500, ≥10 days at diagnosis (p=.002) & prophylaxis with posaconazole suspension (p=.003). 12-week mortality in proven and probable IFI was 31% (11/35). Nine of 11 deceased patients had breakthrough IFI, 8 of whom (5 with mold IFI and 3 with invasive candidiasis) died of the fungal infection.
Conclusion: Patients receiving chemotherapy for AL remain at risk for IFI despite the use of antifungal prophylaxis. In our study, prophylaxis with posaconazole suspension was found to be an independent risk factor for breakthrough IFI. Mortality was high among patients with breakthrough IFI.
K. A. Linder, None
S. Zhou, None
C. A. Kauffman, None
M. H. Miceli, None