title: Risk factors for invasive fusariosis in patients with acute myeloid leukemia and in hematopoietic cell transplant recipients.
abstract: BACKGROUND
  Risk factors for invasive fusariosis (IF) have not been characterized. We attempted to identify risk factors for IF in a prospective cohort of hematologic patients treated in 8 centers in Brazil.
  
  
  METHODS
  Patients with (cases) and without (controls) proven or probable IF diagnosed in a cohort of patients with acute myeloid leukemia (AML) or myelodysplasia (MDS), and in allogeneic hematopoietic cell transplant (HCT) recipients (early, until day 40; late, after day 40 posttransplant) were compared by univariate Cox regression analysis.
  
  
  RESULTS
  Among 237 induction remission courses of AML/MDS and 663 HCTs (345 allogeneic and 318 autologous), 25 cases of IF were diagnosed. In the AML/MDS cohort, active smoking (hazard ratio [HR], 9.11 [95% confidence interval {CI}, 2.04-40.71]) was associated with IF. Variables associated with IF in the early phase of allogeneic HCT were receipt of antithymocyte globulin (HR, 22.77 [95% CI, 4.85-101.34]), hyperglycemia (HR, 5.17 [95% CI, 1.40-19.11]), center 7 (HR, 5.15 [95% CI, 1.66-15.97]), and AML (HR, 4.38 [95% CI, 1.39-13.81]), and in the late phase were nonmyeloablative conditioning regimen (HR, 35.08 [95% CI, 3.90-315.27]), grade III/IV graft-vs-host disease (HR, 16.50 [95% CI, 2.67-102.28]), and previous invasive mold disease (HR, 10.65 [95% CI, 1.19-95.39]).
  
  
  CONCLUSIONS
  Attempts to reduce the risk of IF may include smoking cessation, aggressive control of hyperglycemia, and the use of a mold-active agent as prophylaxis in patients receiving nonmyeloablative HCT or ATG in the conditioning regimen. Future research should further explore smoking and other prehospital variables as risks for IF.
authors.affiliation: Department of Internal Medicine, University Hospital, Universidade Federal do Rio de Janeiro.
authors.forename: Marcia
authors.initials: M
authors.lastname: Garnica
authors.affiliation: Hematology Service, Hospital Naval Marcilio Dias, Rio de Janeiro.
authors.forename: Marcos Oliveira
authors.initials: MO
authors.lastname: da Cunha
authors.affiliation: Department of Internal Medicine, University Hospital, Universidade Federal do Rio de Janeiro.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Portugal
authors.affiliation: Department of Internal Medicine, University Hospital, Universidade Federal do Rio de Janeiro.
authors.forename: Angelo
authors.initials: A
authors.lastname: Maiolino
authors.affiliation: Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.
authors.forename: Arnaldo L
authors.initials: AL
authors.lastname: Colombo
authors.affiliation: Department of Internal Medicine, University Hospital, Universidade Federal do Rio de Janeiro.
authors.forename: Marcio
authors.initials: M
authors.lastname: Nucci
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D060585:Fusariosis / Q000175:diagnosis / Q000209:etiology*; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications; D011446:Prospective Studies; D012074:Remission Induction; D012307:Risk Factors; D012907:Smoking; D066027:Transplant Recipients; D019172:Transplantation Conditioning; D055815:Young Adult
chemical_list: D000961:Antilymphocyte Serum
keywords: acute leukemia; bone marrow transplant; invasive fungal disease; invasive fusariosis; risk factor