title: Does High-Dose Cytarabine Cause More Fungal Infection in Patients With Acute Myeloid Leukemia Undergoing Consolidation Therapy: A Multicenter, Prospective, Observational Study in China.
abstract: Invasive fungal infection (IFI) remains as a significant cause of morbidity and mortality in patients with acute myelogenous leukemia (AML). Here, we report the subgroup analysis of China Assessment of Antifungal Therapy in Haematological Disease (CAESAR) study to evaluate the risk of IFI in patients with AML in 1st remission receiving high-dose cytarabine (HiDAC) as consolidation. A total of 638 patients with AML in 1st complete remission were selected from the database. Among them, 130 patients received HiDAC alone with total dose of 2-3 g/m(2) × 6 while 508 patients received multiple-agent combination chemotherapy (multiagent chemo group). The patients' characteristics were generally not different but more patients in HiDAC group had peripherally inserted central catheter (61.5% vs 44.5%, P = 0.002). The median duration of neutropenia was 8.0 days in both HiDAC (2-20) and multiagent chemo group (2-28). Number of patients with prolonged neutropenia (>14 days) tended to be more in multiagent chemo group but not significant different (16.3% vs 8.8%, respectively). There was no significant difference between 2 groups in persistent neutropenic fever (40.8% vs 33.1%), antifungal treatment (11.5% vs 11.4%), and incidence of proven/probable IFI (4 probable in HiDAC vs 1 proven/4 probable in multiagent chemo, P = 0.35) or possible IFI. As to the clinical outcome in terms of duration of hospitalization and death in remission, there was a trend of shorter duration of hospitalization in HiDAC (19 days, 3-70) compare to multiagent chemo group (21 days, 1-367, P = 0.057) while no death documented in HiDAC group and only 2 patients died in the multiagent chemo group (0.4%). As to risk factors associated with IFI in all 638 patients, there was a trend of more IFI in patients with severe neutropenia (3.0%, P = 0.089) and previous history of IFI (3.85%, P = 0.086) while the antifungal prophylaxis was not associated significantly reduced IFI. Overall, our data support the perception that HiDAC alone as consolidation in first remission AML patients was well tolerated and not associated with increased hematological toxicity and IFI than conventional combination chemotherapy. Antifungal prophylaxis may not necessary except for patients with previous history of IFI.
authors.affiliation: From the Blood and Marrow Transplantation Center, Department of Hematology, Collaborative Innovation Center of Hematology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai (LW, JH); Peking University Institute of Hematology, Peking University, People's Hospital, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing (YS, XH); The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou (HH, JJ); Shanghai Children's Medical Center, Shanghai (JC); Jiangsu Province Hospital, Nanjing (JL); Harbin Hematologic Tumor Institution, Harbin (JM); The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou (JL); Tangdu Hospital, Fourth Military Medical University, Xi'an (YL); Changhai Hospital of the Second Military Medical University, Shanghai (JW); The First Affiliated Hospital of China Medical University, Shengyang (YL); The First Affiliated Hospital of Wenzhou Medical College, Wenzhou (KY); Fujian Medical University Union Hospital, Fuzhou (JH); The First People's Hospital of Shanghai, Shanghai (CW); The First Affiliated Hospital of Soochow University, Suzhou (DW); and The General Hospital of Guangzhou Military Command of PLA, Guangzhou, People's Republic of China (YX).
authors.forename: Ling
authors.initials: L
authors.lastname: Wang
authors.forename: Jiong
authors.initials: J
authors.lastname: Hu
authors.forename: Yuqian
authors.initials: Y
authors.lastname: Sun
authors.forename: He
authors.initials: H
authors.lastname: Huang
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.forename: Jianyong
authors.initials: J
authors.lastname: Li
authors.forename: Jun
authors.initials: J
authors.lastname: Ma
authors.forename: Juan
authors.initials: J
authors.lastname: Li
authors.forename: Yingmin
authors.initials: Y
authors.lastname: Liang
authors.forename: Jianmin
authors.initials: J
authors.lastname: Wang
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.forename: Kang
authors.initials: K
authors.lastname: Yu
authors.forename: Jianda
authors.initials: J
authors.lastname: Hu
authors.forename: Jie
authors.initials: J
authors.lastname: Jin
authors.forename: Chun
authors.initials: C
authors.lastname: Wang
authors.forename: Depei
authors.initials: D
authors.lastname: Wu
authors.forename: Yang
authors.initials: Y
authors.lastname: Xiao
authors.forename: Xiaojun
authors.initials: X
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D018943:Anthracyclines / Q000008:administration & dosage; D000935:Antifungal Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D064146:Chemotherapy-Induced Febrile Neutropenia / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D060830:Consolidation Chemotherapy / Q000009:adverse effects; D003561:Cytarabine / Q000008:administration & dosage* / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007902:Length of Stay; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000139:chemically induced* / Q000453:epidemiology* / Q000517:prevention & control; D011446:Prospective Studies; D015996:Survival Rate; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives; D055815:Young Adult
chemical_list: D018943:Anthracyclines; D000935:Antifungal Agents; D003561:Cytarabine; D014740:Vidarabine; C024352:fludarabine
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