In a nutshell
The aim of this study was to examine the effect of preventative fungal treatment in acute leukemia patients with different risk factors. Researchers identified a number of risk factors that can increase the incidence of a severe fungal infection after chemotherapy. Preventative fungal treatment for patients undergoing primary chemotherapy is highly recommended.
Some background
Fungal infections are a severe complication following chemotherapy. Invasive fungal disease (IFD) are those infections where fungi have invaded the deep tissues, which can cause prolonged illness. About 10% of patients with acute leukemia develop IFD. Mortality rates of IFD are estimated between 27 and 60%. Prophylactic fungal treatment can be given to prevent IFD from occurring. The impact of such treatment on acute leukemia patients with different risk factors is unclear.
Methods & findings
The records of 2,015 acute leukemia patients were analyzed. This included a total of 2,274 courses of chemotherapy. 1,410 of these courses were received by acute myeloid leukemia patients. 864 courses were received by acute lymphocytic leukemia patients. Prophylactic fungal treatment was administered in 491 patients for an average of 10 days.
228 cases (10% of patients) of IFD were identified. This included 168 possible, 51 probable, and 9 proven cases. The incidence rate was significantly higher in acute myeloid leukemia patients (11.8%) compared to acute lymphocytic leukemia patients (7.1%).
Undergoing induction chemotherapy (with the aim of inducing a remission) was more likely to result in IFD compared to consolidation chemotherapy (with the aim to maintain a remission). The overall incidence of IFD was only 3.7% in patients receiving consolidation chemotherapy. Other risk factors for IFD included low albumin (a protein made by the liver) levels in the blood, having a central line to a vein, being fed through a central line, and male gender.
Prophylactic fungal treatment significantly reduced the incidence of IFD in patients receiving induction chemotherapy. The incidence rate without prophylaxis was 24.7% compared to 13.7% with prophylaxis.
Prophylactic fungal treatment showed no apparent benefit for patients receiving consolidation chemotherapy. However, patients with more than three risk factors may benefit from prophylaxis before consolidation chemotherapy.
The bottom line
This study concluded that prophylactic fungal treatment is highly recommended for acute leukemia patients undergoing induction chemotherapy.
The fine print
Studies that randomly assign patients to treatment groups are needed to confirm these results.
Published By :
International journal of hematology
Date :
Aug 20, 2017
