title: Epidemiology, outcomes, and risk factors of invasive fungal infections in adult patients with acute myelogenous leukemia after induction chemotherapy.
abstract: This is a retrospective, single-center study of adult patients with newly diagnosed acute myelogenous leukemia (AML), who received intensive induction timed sequential chemotherapy from 1/2005 to 6/2010. Among 254 consecutive AML patients, 123 (48.4%) developed an invasive fungal infection (IFI): 14 (5.5%) patients with invasive candidiasis (IC) and 108 (42.5%) patients with invasive mould infections (IMI). Among 108 IMI identified, 4 (3.7%) were proven, 1 (0.9%) probable, and 103 (95.4%) were possible, using current definitions. Overall, 6-month mortality was 23.7% (27/114) and 20.6% (26/126) for patients with and without an IFI, respectively. Older age (≥50 years; hazard ratio [HR]: 2.5, P < 0.001), female gender (HR: 1.7, P = 0.006), and baseline renal and/or liver dysfunction (HR: 2.4, P < 0.001) were the strongest mortality predictors. We report relatively low rates of IC despite lack of routine primary antifungal prophylaxis, albeit associated with poor long-term survival. High rates of IMI, the vast majority with a possible diagnosis, were observed. Host-related variables (demographics and baseline organ dysfunction) were identified as the most significant risk factors for IFI and mortality predictors in this series.
authors.affiliation: Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA. dneofyt1@jhmi.edu
authors.forename: Dionissios
authors.initials: D
authors.lastname: Neofytos
authors.forename: Kit
authors.initials: K
authors.lastname: Lu
authors.forename: Amy
authors.initials: A
authors.lastname: Hatfield-Seung
authors.forename: Amanda
authors.initials: A
authors.lastname: Blackford
authors.forename: Kieren A
authors.initials: KA
authors.lastname: Marr
authors.forename: Suzanne
authors.initials: S
authors.lastname: Treadway
authors.forename: Darin
authors.initials: D
authors.lastname: Ostrander
authors.forename: Veronique
authors.initials: V
authors.lastname: Nussenblatt
authors.forename: Judith
authors.initials: J
authors.lastname: Karp
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005334:Fever / Q000097:blood / Q000382:microbiology; D006801:Humans; D060828:Induction Chemotherapy; D053208:Kaplan-Meier Estimate; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications* / Q000453:epidemiology; D009503:Neutropenia / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016896:Treatment Outcome