Epidemiology of invasive fungal diseases in adults with newly diagnosed acute myeloid leukemia

Abstract

Invasive fungal diseases (IFDs) are common in patients with acute myeloid leukemia (AML), but no recent data on incidence without antifungal prophylaxis are available. We evaluated the incidence of IFDs in patients with AML undergoing induction chemotherapy at Stanford University Hospital from 2012 to 2017, for up to 12 weeks after induction. We also analyzed factors associated with IFD development. Thirty-six of 240 patients (13%) developed at least one proven or probable IFD. Seventy-eight percent of the proven or probable IFDs were due to Candida or Aspergillus species. Infection due to Fusarium and Mucorales was uncommon. Absolute neutrophil count (ANC) of <500 µL/L at the start of induction was associated with an increased risk of IFD. One hundred and eighty-seven patients (78%) were started on systemic antifungal drugs, even without microbiologic evidence of an IFD. IFDs remain frequent in AML patients undergoing induction chemotherapy without antifungal prophylaxis.

Keywords:

• Acute myeloid leukemia
• induction chemotherapy
• invasive fungal diseases
• antifungal agents
• antifungal prophylaxis

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Five additional patients developed probable or proven IFDs more than seven days after antifungals were started, and were therefore censored in time-to-event analysis. These included two patients with baseline severe neutropenia and three patients without baseline severe neutropenia. Including these censored values, 20 (21.3%) patients with baseline severe neutropenia and 11 (7.5%) without baseline severe neutropenia had a probable of proven IFD at any point during this study.