High Incidences of Invasive Fungal Infections in Acute Myeloid Leukemia Patients Receiving Induction Chemotherapy without Systemic Antifungal Prophylaxis: A Prospective Observational Study in Taiwan

• Published in: PloS one Vol. 10; no. 6; p. e0128410
• Main Authors: Tang, Jih-Luh, Kung, Hsiang-Chi, Lei, Weng-Chi, Yao, Ming, Wu, Un-In, Hsu, Szu-Chun, Lin, Chien-Ting, Li, Chi-Cheng, Wu, Shang-Ju, Hou, Hsin-An, Chou, Wen-Chien, Huang, Shang-Yi, Tsay, Woei, Chen, Yao-Chang, Chen, Yee-Chun, Chang, Shan-Chwen, Ko, Bor-Sheng, Tien, Hwei-Fang
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 10.06.2015; Public Library of Science (PLoS)
• Subjects: Acute myelocytic leukemia; Acute myeloid leukemia; Adolescent; Adult; Aged; Aged, 80 and over; Antifungal agents; Antifungal Agents - therapeutic use; Antineoplastic agents; Blood cancer; Cancer research; Care and treatment; Chemotherapy; Demographics; Diagnostic systems; Epidemiology; Female; Fungi; Fungicides; Health aspects; Humans; Induction Chemotherapy; Infection; Infections; Insurance claims; Invasiveness; Leukemia; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - epidemiology; Leukemia, Myeloid, Acute - microbiology; Male; Markov analysis; Middle Aged; Mortality; Mycoses; Mycoses - epidemiology; Mycoses - prevention & control; Myeloid leukemia; Observational studies; Patients; Pre-Exposure Prophylaxis; Prophylaxis; Prospective Studies; Remission; Remission Induction; Respiratory tract; Risk analysis; Risk Factors; Survival; Taiwan - epidemiology; Textbooks; Treatment Outcome; Yeast; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0128410

Invasive fungal infections (IFIs) is an important complication for acute myeloid leukemia (AML) patients receiving induction chemotherapy. However, the epidemiological information is not clear in Southeastern Asia, an area of potential high incidences of IFIs. To clarify it, we enrolled 298 non-M3 adult AML patients receiving induction chemotherapy without systemic anti-fungal prophylaxis from Jan 2004 to Dec 2009, when we applied a prospective diagnostic and treatment algorithm for IFIs. Their demographic parameters, IFI characters, and treatment outcome were collected for analysis. The median age of these patients was 51 years. Standard induction chemotherapy was used for 246 (82.6%) patients, and 66.8% of patients achieved complete remission (CR) or partial remission. The incidence of all-category IFIs was 34.6% (5.7% proven IFIs, 5.0% probable IFIs and 23.8% possible IFIs). Candida tropicalis was the leading pathogen among yeast, and lower respiratory tract was the most common site for IFIs (75.4%, 80/106). Standard induction chemotherapy and failure to CR were identified as risk factors for IFIs. The presence of IFI in induction independently predicted worse survival (hazard ratio 1.536 (1.100-2.141), p value = 0.012). Even in those who survived from the initial IFI insults after 3 months, the presence of IFIs in induction still predicted a poor long-term survival. This study confirms high incidences of IFIs in Southeastern Asia, and illustrates potential risk factors; poor short-term and long-term outcomes are also demonstrated. This epidemiological information will provide useful perspectives for anti-fungal prophylaxis and treatment for AML patients during induction, so that best chances of cure and survival can be provided.