title: Primary fungal prophylaxis in acute leukemia patients with different risk factors: retrospective analysis from the CAESAR study.
abstract: Invasive fungal disease (IFD) is a major cause of morbidity and mortality in acute leukemia (AL) patients. The impact of primary antifungal prophylaxis (PAP) on AL patients with different risk factors is unclear. We analyzed 2015 Chinese AL patients who received a total of 2274 chemotherapy courses, including 1410 courses in acute myeloid leukemia (AML) patients and 864 courses in acute lymphocytic leukemia (ALL) patients. The IFD incidence was significantly higher among AML than ALL patients (11.8 vs. 7.1%, P < 0.001) and in patients receiving induction chemotherapy than in those receiving consolidation chemotherapy (21.6 vs. 3.7%, P < 0.001). Induction chemotherapy, decreased serum albumin, indwelling central venous catheters, parenteral nutrition, and male gender were independent risk factors for IFD in AL patients, whereas PAP independently protected against IFD development. For patients on induction chemotherapy, PAP significantly reduced IFD incidence (P < 0.001). For patients on consolidation chemotherapy, however, PAP did not significantly alter IFD incidence, although PAP did lower IFD incidence in patients with certain risk factors. PAP is highly recommended for patients on induction therapy; for those on consolidation chemotherapy, PAP should be considered for patients who present with severe neutropenia, decreased albumin, and/or an indwelling central venous catheter.
authors.affiliation: Hematopoietic Stem Cell Transplantation Center, Institute of Hematology and Hospital of Blood Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 288 Nanjing Road, Heping District, 300020, Tianjin, China.
authors.forename: Rongli
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Department of Hematology/Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 200129, Shanghai, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Chen
authors.affiliation: Hematopoietic Stem Cell Transplantation Center, the First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, China.
authors.forename: He
authors.initials: H
authors.lastname: Huang
authors.affiliation: Harbin Institute of Hematology and Oncology, Harbin, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Ma
authors.affiliation: Nanfang Hospital, Nanfang Medical University, Guangzhou, China.
authors.forename: Fanyi
authors.initials: F
authors.lastname: Meng
authors.affiliation: Division of Hematology-Oncology, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Yongmin
authors.initials: Y
authors.lastname: Tang
authors.affiliation: Department of Hematology, Fujian Medical University Union Hospital, Fuzhou, China.
authors.forename: Jianda
authors.initials: J
authors.lastname: Hu
authors.affiliation: Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
authors.forename: Xi
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Peking University People's Hospital, Peking University Institute of Hematology, No 11, Xizhimennan Street, Xicheng District, 100044, Beijing, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Ji
authors.affiliation: Department of Hematology, Affiliated Hospital of Academy of Military Medical Sciences, Beijing, China.
authors.forename: Huisheng
authors.initials: H
authors.lastname: Ai
authors.affiliation: Department of Hematology, TangDu Hospital, Fourth Military Medical University, Xi'an, China.
authors.forename: Yingmin
authors.initials: Y
authors.lastname: Liang
authors.affiliation: Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China.
authors.forename: Depei
authors.initials: D
authors.lastname: Wu
authors.affiliation: Peking University People's Hospital, Peking University Institute of Hematology, No 11, Xizhimennan Street, Xicheng District, 100044, Beijing, China. xjhrm@medmail.com.cn.
authors.forename: Xiaojun
authors.initials: X
authors.lastname: Huang
authors.affiliation: Hematopoietic Stem Cell Transplantation Center, Institute of Hematology and Hospital of Blood Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 288 Nanjing Road, Heping District, 300020, Tianjin, China. mzhan1960@sina.com.
authors.forename: Mingzhe
authors.initials: M
authors.lastname: Han
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000008:administration & dosage*; D044466:Asian People; D062905:Central Venous Catheters / Q000009:adverse effects / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D060830:Consolidation Chemotherapy; D005260:Female; D006801:Humans; D015994:Incidence; D060828:Induction Chemotherapy; D007223:Infant; D007938:Leukemia / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D009503:Neutropenia; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin; D012737:Sex Factors; D014230:Triazoles / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D012709:Serum Albumin; D014230:Triazoles
keywords: Chemotherapy; Invasive fungal disease; Leukemia; Neutropenia; Prophylaxis