title: Pre-chemotherapy risk factors for invasive fungal diseases: prospective analysis of 1,192 patients with newly diagnosed acute myeloid leukemia (SEIFEM 2010-a multicenter study).
abstract: Correct definition of the level of risk of invasive fungal infections is the first step in improving the targeting of preventive strategies. We investigated the potential relationship between pre-hospitalization exposure to sources of fungi and the development of invasive fungal infections in adult patients with newly diagnosed acute myeloid leukemia after their first course of chemotherapy. From January 2010 to April 2012, all consecutive acute myeloid leukemia patients in 33 Italian centers were prospectively registered. Upon first admission, information about possible pre-chemotherapy risk factors and environmental exposure was collected. We recorded data regarding comorbid conditions, employment, hygienic habits, working and living environment, personal habits, hobbies, and pets. All invasive fungal infections occurring within 30 days after the first course of chemotherapy were recorded. Of the 1,192 patients enrolled in this study, 881 received intensive chemotherapy and were included in the present analysis. Of these, 214 developed an invasive fungal infection, including 77 proven/probable cases (8.7%). Of these 77 cases, 54 were proven/probable invasive mold infections (6.1%) and 23 were proven yeast infections (2.6%). Upon univariate analysis, a significant association was found between invasive mold infections and age, performance status, diabetes, chronic obstructive pulmonary disease, smoking, cocaine use, job, hobbies, and a recent house renovation. Higher body weight resulted in a reduced risk of invasive mold infections. Multivariate analysis confirmed the role of performance status, job, body weight, chronic obstructive pulmonary disease, and house renovation. In conclusion, several hospital-independent variables could potentially influence the onset of invasive mold infections in patients with acute myeloid leukemia. Investigation of these factors upon first admission may help to define a patient's risk category and improve targeted prophylactic strategies. (Clinicaltrial.gov: NCT01315925)
authors: Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma morenacaira@yahoo.it.
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authors: Ematologia, Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Roma.
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authors: Antonella
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authors: Ferrari
authors: Divisione di Ematologia, Ospedale San Camillo, Roma.
authors: Mariagrazia
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authors: Garzia
authors: Divisione di Ematologia, Università Cattolica del S.Cuore, Campobasso.
authors: Cristina
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authors: Ematologia ed Immunologia Clinica, Dipartimento di Medicina, Universita' di Padova.
authors: Federica
authors: F
authors: Lessi
authors: Unità Complessa di Oncoematologia, Ospedale di La Spezia.
authors: Annunziata
authors: A
authors: Manna
authors: Divisione di Ematologia, Azienda Ospedaliera "Bianchi Melacrino Morelli", Reggio Calabria.
authors: Bruno
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authors: Martino
authors: UOC Ematologia, Azienda Ospedaliera Universitaria Integrata di Verona.
authors: Gianpaolo
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authors: Nadali
authors: Clinica di Ematologia, Università di Ancona.
authors: Massimo
authors: M
authors: Offidani
authors: Divisione di Ematologia e Centro Trapianti Midollo, Ospedale Niguarda Ca' Granda, Milan.
authors: Laura
authors: L
authors: Paris
authors: Clinica di Ematologia, Ospedale di Tricase.
authors: Vincenzo
authors: V
authors: Pavone
authors: Divisione di Ematologia, Spedali Civili di Brescia.
authors: Giuseppe
authors: G
authors: Rossi
authors: Unità di Ematologia, Istituti Fisioterapici Ospitalieri, Roma.
authors: Antonio
authors: A
authors: Spadea
authors: Hematology and BMT Unit, Department of Emergency and Organ Transplantation, University of Bari, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari.
authors: Giorgina
authors: G
authors: Specchia
authors: Istituto di Malattie Infettive, Università Cattolica del Sacro Cuore, Roma.
authors: Enrico Maria
authors: EM
authors: Trecarichi
authors: Ematologia-CTMO" Ospedale Roberto Binaghi Cagliari.
authors: Adriana
authors: A
authors: Vacca
authors: Emato-Oncologia Pediatrica, Azienda Ospedaliera Universitaria Integrata, Verona.
authors: Simone
authors: S
authors: Cesaro
authors: Istituto di Ematologia, Ospedale S. Maria della Misericordia, Università di Perugia, Italy.
authors: Vincenzo
authors: V
authors: Perriello
authors: Sezione di Ematologia, Università di Parma.
authors: Franco
authors: F
authors: Aversa
authors: Istituto di Malattie Infettive, Università Cattolica del Sacro Cuore, Roma.
authors: Mario
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authors: Tumbarello
authors: Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma.
authors: Livio
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authors: Pagano
mesh_terms: D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016867:Immunocompromised Host; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000209:etiology*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D000935:Antifungal Agents
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