Low Rate of Invasive Fungal Infections During Induction and Consolidation Chemotherapy for Adults with De Novo Acute Myeloid Leukemia Without Anti-mold Prophylaxis: Single-Center 2002-2018 Empirical/Pre-emptive Approach
Por:
Martino, R, Garrido, A, Santaliestra, M, Garcia-Cadenas, I, Novelli, S, Saavedra, SD, Esquirol, A, Granell, M, Briones, J, Moreno, C, Brunet, S, Gimenez, A, Hidalgo, A, Sanchez, F, Sierra, J
Publicada:
1 ago 2020
Ahead of Print:
1 jun 2020
Resumen:
Broad-spectrum antifungal prophylaxis is currently considered the standard of care for adults with de novo AML for the prevention of invasive fungal infections (IFIs), especially invasive pulmonary aspergillosis (IPA). Because fluconazole has been used in our center as anti-yeast prophylaxis, we sought to analyze in detail the incidence of IFIs over a 17-year period, as well as their impact on outcome. A standardized protocol of patient management, including serum galactomannan screening and thoracic CT-guided diagnostic-driven antifungal therapy, was used in all patients. A total of 214 consecutive adults with de novo AML who were treated in 3 CETLAM (Grupo Cooperativo para el Estudio y Tratamiento de las Leucemias Agudas y Mielodisplasias) protocols from 2002 to 2018 were included. The 90-day incidence of any IFI (including possible cases) was 11% (95% CI 4-15%), most cases occurred during induction chemotherapy (8%, 95% CI 4-12%), and most cases were probable/proven IPA (8%, 95% CI 3-13%). Developing an IFI during induction and consolidation had no impact on 1-year survival. A case-control study with 23 cases of IPA and 69 controls identified induction/re-induction chemotherapy, chronic pulmonary disease and age > 60 years/poor baseline performance status as potential pretreatment risk factors. The current study proves that inpatient induction and consolidation chemotherapy for de novo AML can be given in areas with "a priori" high-burden of airborne molds with fluconazole prophylaxis, while the selective use of anti-mold prophylaxis in patients at very high risk may further reduce the incidence of IFI in this specific clinical scenario.
Filiaciones:
Martino, R:
Univ Autonoma Barcelona, Div Clin Hematol, Dept Radiol, Hosp St Creu & St Pau, Ave Mas Casanovas 90, Barcelona 08041, Spain
Univ Autonoma Barcelona, Dept Microbiol, Hosp St Creu & St Pau, Barcelona, Spain
Garrido, A:
Univ Autonoma Barcelona, Div Clin Hematol, Dept Radiol, Hosp St Creu & St Pau, Ave Mas Casanovas 90, Barcelona 08041, Spain
Univ Autonoma Barcelona, Dept Microbiol, Hosp St Creu & St Pau, Barcelona, Spain
Santaliestra, M:
Univ Autonoma Barcelona, Div Clin Hematol, Dept Radiol, Hosp St Creu & St Pau, Ave Mas Casanovas 90, Barcelona 08041, Spain
Univ Autonoma Barcelona, Dept Microbiol, Hosp St Creu & St Pau, Barcelona, Spain
Garcia-Cadenas, I:
Univ Autonoma Barcelona, Div Clin Hematol, Dept Radiol, Hosp St Creu & St Pau, Ave Mas Casanovas 90, Barcelona 08041, Spain
Univ Autonoma Barcelona, Dept Microbiol, Hosp St Creu & St Pau, Barcelona, Spain
Novelli, S:
Univ Autonoma Barcelona, Div Clin Hematol, Dept Radiol, Hosp St Creu & St Pau, Ave Mas Casanovas 90, Barcelona 08041, Spain
Univ Autonoma Barcelona, Dept Microbiol, Hosp St Creu & St Pau, Barcelona, Spain
Saavedra, SD:
Univ Autonoma Barcelona, Div Clin Hematol, Dept Radiol, Hosp St Creu & St Pau, Ave Mas Casanovas 90, Barcelona 08041, Spain
Univ Autonoma Barcelona, Dept Microbiol, Hosp St Creu & St Pau, Barcelona, Spain
Esquirol, A:
Univ Autonoma Barcelona, Div Clin Hematol, Dept Radiol, Hosp St Creu & St Pau, Ave Mas Casanovas 90, Barcelona 08041, Spain
Univ Autonoma Barcelona, Dept Microbiol, Hosp St Creu & St Pau, Barcelona, Spain
Granell, M:
Univ Autonoma Barcelona, Div Clin Hematol, Dept Radiol, Hosp St Creu & St Pau, Ave Mas Casanovas 90, Barcelona 08041, Spain
Univ Autonoma Barcelona, Dept Microbiol, Hosp St Creu & St Pau, Barcelona, Spain
Briones, J:
Univ Autonoma Barcelona, Div Clin Hematol, Dept Radiol, Hosp St Creu & St Pau, Ave Mas Casanovas 90, Barcelona 08041, Spain
Univ Autonoma Barcelona, Dept Microbiol, Hosp St Creu & St Pau, Barcelona, Spain
Moreno, C:
Univ Autonoma Barcelona, Div Clin Hematol, Dept Radiol, Hosp St Creu & St Pau, Ave Mas Casanovas 90, Barcelona 08041, Spain
Univ Autonoma Barcelona, Dept Microbiol, Hosp St Creu & St Pau, Barcelona, Spain
Brunet, S:
Univ Autonoma Barcelona, Div Clin Hematol, Dept Radiol, Hosp St Creu & St Pau, Ave Mas Casanovas 90, Barcelona 08041, Spain
Univ Autonoma Barcelona, Dept Microbiol, Hosp St Creu & St Pau, Barcelona, Spain
Gimenez, A:
Univ Autonoma Barcelona, Div Clin Hematol, Dept Radiol, Hosp St Creu & St Pau, Ave Mas Casanovas 90, Barcelona 08041, Spain
Hidalgo, A:
Univ Autonoma Barcelona, Div Clin Hematol, Dept Radiol, Hosp St Creu & St Pau, Ave Mas Casanovas 90, Barcelona 08041, Spain
Sanchez, F:
Univ Autonoma Barcelona, Dept Microbiol, Hosp St Creu & St Pau, Barcelona, Spain
Sierra, J:
Univ Autonoma Barcelona, Div Clin Hematol, Dept Radiol, Hosp St Creu & St Pau, Ave Mas Casanovas 90, Barcelona 08041, Spain
Univ Autonoma Barcelona, Dept Microbiol, Hosp St Creu & St Pau, Barcelona, Spain
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