title: High Incidences of Invasive Fungal Infections in Acute Myeloid Leukemia Patients Receiving Induction Chemotherapy without Systemic Antifungal Prophylaxis: A Prospective Observational Study in Taiwan.
abstract: 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.
authors.affiliation: Division of Hematology, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan; Tai-Cheng Stem Cell Therapy Center, National Taiwan University, Taipei, Taiwan.
authors.forename: Jih-Luh
authors.initials: JL
authors.lastname: Tang
authors.affiliation: Division of Infection, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Hsiang-Chi
authors.initials: HC
authors.lastname: Kung
authors.affiliation: Division of Hematology, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Weng-Chi
authors.initials: WC
authors.lastname: Lei
authors.affiliation: Division of Hematology, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Ming
authors.initials: M
authors.lastname: Yao
authors.affiliation: Clinical Trial Center, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Un-In
authors.initials: UI
authors.lastname: Wu
authors.affiliation: Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Szu-Chun
authors.initials: SC
authors.lastname: Hsu
authors.affiliation: Tai-Cheng Stem Cell Therapy Center, National Taiwan University, Taipei, Taiwan.
authors.forename: Chien-Ting
authors.initials: CT
authors.lastname: Lin
authors.affiliation: Tai-Cheng Stem Cell Therapy Center, National Taiwan University, Taipei, Taiwan.
authors.forename: Chi-Cheng
authors.initials: CC
authors.lastname: Li
authors.affiliation: Division of Hematology, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Shang-Ju
authors.initials: SJ
authors.lastname: Wu
authors.affiliation: Division of Hematology, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Hsin-An
authors.initials: HA
authors.lastname: Hou
authors.affiliation: Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Chou
authors.affiliation: Division of Hematology, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Shang-Yi
authors.initials: SY
authors.lastname: Huang
authors.affiliation: Division of Hematology, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Woei
authors.initials: W
authors.lastname: Tsay
authors.affiliation: Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yao-Chang
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Division of Infection, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan; National Institute of Infectious Diseases and Vaccinology, National health Research Institute, Miaoli, Taiwan.
authors.forename: Yee-Chun
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Division of Infection, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Shan-Chwen
authors.initials: SC
authors.lastname: Chang
authors.affiliation: Division of Hematology, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Bor-Sheng
authors.initials: BS
authors.lastname: Ko
authors.affiliation: Division of Hematology, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Hwei-Fang
authors.initials: HF
authors.lastname: Tien
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology* / Q000517:prevention & control; D065129:Pre-Exposure Prophylaxis; D011446:Prospective Studies; D012074:Remission Induction; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents