Incidence of invasive fungal infection in acute lymphoblastic and acute myelogenous leukemia in the era of antimold prophylaxis

• Published in: Scientific reports Vol. 11; no. 1; p. 22160
• Main Authors: Oh, Sang-Min, Byun, Ja Min, Chang, Euijin, Kang, Chang Kyung, Shin, Dong-Yeop, Koh, Youngil, Hong, Junshik, Kim, Taek Soo, Choe, Pyoeng Gyun, Park, Wan Beom, Kim, Nam Joong, Yoon, Sung-Soo, Kim, Inho, Oh, Myoung-don
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 12.11.2021; Nature Publishing Group; Nature Portfolio
• Subjects: 692/499; 692/699/1541/1990/283/1897; 692/699/1541/1990/283/2125; 692/699/255/1672; Acute lymphoblastic leukemia; Acute myeloid leukemia; Adult; Antifungal Agents - therapeutic use; Chemotherapy; Disease prevention; Disease Susceptibility; Female; Fungal infections; Humanities and Social Sciences; Humans; Incidence; Invasive Fungal Infections - epidemiology; Invasive Fungal Infections - etiology; Invasive Fungal Infections - prevention & control; Invasiveness; Leukemia; Leukemia, Myeloid, Acute - complications; Leukemia, Myeloid, Acute - epidemiology; Lymphatic leukemia; Male; Middle Aged; multidisciplinary; Myeloid leukemia; Neutropenia; Odds Ratio; Patients; Pre-Exposure Prophylaxis; Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications; Precursor Cell Lymphoblastic Leukemia-Lymphoma - epidemiology; Prophylaxis; Risk Assessment; Risk Factors; Science; Science (multidisciplinary)
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-021-01716-2

The incidence of invasive fungal infection (IFI) in patients with acute myeloid leukemia (AML) has decreased with the introduction of antimold prophylaxis. Although acute lymphoblastic leukemia (ALL) has a lower risk of IFI than does AML, the incidences of IFI in both AML and ALL in the era of antimold prophylaxis should be re-evaluated. We analyzed adults with AML or ALL who had undergone induction, re-induction, or consolidation chemotherapy from January 2017 to December 2019 at Seoul National University Hospital. Their clinical characteristics during each chemotherapy episode were reviewed, and cases with proven or probable diagnoses were regarded as positive for IFI. Of 552 episodes (393 in AML and 159 in ALL), 40 (7.2%) were IFI events. Of the IFI episodes, 8.1% (12/148) and 5.9% (13/220) ( P  = 0.856) occurred in cases of ALL without antimold prophylaxis and AML with antimold prophylaxis, respectively. After adjusting for clinical factors, a lack of antimold prophylaxis (adjusted odds ratio [aOR], 3.52; 95% confidence interval [CI], 1.35–9.22; P  = 0.010) and a longer duration of neutropenia (per one day, aOR, 1.02; 95% CI, 1.01–1.04; P  = 0.001) were independently associated with IFI. In conclusion, the incidence of IFI in ALL without antimold prophylaxis was not lower than that in AML. A lack of antimold prophylaxis and prolonged neutropenia were independent risk factors for IFI. Clinicians should be on guard for detecting IFI in patients with ALL, especially those with risk factors.