title: Invasive fungal infections in AML/MDS patients treated with azacitidine: a risk worth considering antifungal prophylaxis?
abstract: The aim of this study is to analyse the risk of invasive fungal infection (IFI) and the need for antifungal prophylaxis in patients with acute myeloid leukaemia and myelodysplastic syndromes (AML/MDS) treated with azacitidine. We retrospectively analysed the incidence of IFI according to EORTC-MSG criteria in 121 consecutive AML/MDS patients receiving 948 azacitidine courses (median 5, range 1-43) between June 2007 and June 2015. Four cases of IFI (two possible, one probable aspergillosis and one proven candidemia) occurred in this series. The incidence rate of proven/probable IFI was 0.21% per treatment cycle and 1.6% per patient treated for the whole series, and 0.73% per treatment cycle and 4.1% per patient treated in those with severe neutropenia. Two patients died from IFI, leading to an IFI-attributable mortality rate of 1.65% per patient and 0.21% per treatment cycle. The numbers needed to treat with prophylaxis to prevent one case of IFI are 238 azacitidine cycles or 30 patients throughout their whole treatment course, and 137 azacitidine cycles or 24 patients among those with severe neutropenia. AML/MDS patients treated with azacitidine, including those with severe prolonged neutropenia, have a very low risk of IFI which does not justify the use of antifungal prophylaxis.
authors.affiliation: Department of Haematology, Catalan Institute of Oncology - Hospital Duran i Reynals, Biomedical Research Institute of Bellvitge (Idibell), Barcelona, Spain.
authors.forename: Helena
authors.initials: H
authors.lastname: Pomares
authors.affiliation: Department of Haematology, Catalan Institute of Oncology - Hospital Duran i Reynals, Biomedical Research Institute of Bellvitge (Idibell), Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Arnan
authors.affiliation: Department of Haematology, Catalan Institute of Oncology - Hospital Duran i Reynals, Biomedical Research Institute of Bellvitge (Idibell), Barcelona, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Sánchez-Ortega
authors.affiliation: Department of Haematology, Catalan Institute of Oncology - Hospital Duran i Reynals, Biomedical Research Institute of Bellvitge (Idibell), Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Sureda
authors.affiliation: Department of Haematology, Catalan Institute of Oncology - Hospital Duran i Reynals, Biomedical Research Institute of Bellvitge (Idibell), Barcelona, Spain.
authors.forename: Rafael F
authors.initials: RF
authors.lastname: Duarte
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D000935:Antifungal Agents / Q000627:therapeutic use*; D000964:Antimetabolites, Antineoplastic / Q000009:adverse effects / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D001374:Azacitidine / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000072742:Invasive Fungal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D054437:Myelodysplastic-Myeloproliferative Diseases / Q000150:complications* / Q000188:drug therapy; D009503:Neutropenia / Q000150:complications; D061366:Numbers Needed To Treat; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014230:Triazoles / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D000964:Antimetabolites, Antineoplastic; D014230:Triazoles; D001374:Azacitidine
keywords: Azacitidine; acute myeloid leukaemia; antifungal prophylaxis; invasive fungal infections; myelodysplastic syndromes