Invasive fungal infection following chemotherapy for acute myeloid leukaemia—Experience from a developing country

Abstract

The incidence of invasive fungal infections (IFI) is believed to be higher in patients with acute myeloid leukaemia (AML) undergoing chemotherapy in non-HEPA-filtered rooms. The aim of this study is to review the incidence of IFI in a large cohort of patients with AML treated at a single centre in India. Two hundred and twenty-two patients with AML treated with either induction chemotherapy or salvage chemotherapy between 2008 and 2013 were studied retrospectively. IFI was defined as per the revised EORTC-MSG criteria. Data on type of chemotherapy, prophylactic strategies, engraftment (ANC>500), the presence of IFI and survival were collected. IFI was diagnosed in 86 patients (38.7%) with proven IFI in 12 (5.4%). Use of posaconazole prophylaxis (P=.001) was the only factor associated with reduced incidence of IFI. Survival in patients with proven IFI was lower than those without proven IFI, but not statistically significant (59.4% vs 78.5%; P=.139). There is a high incidence of IFI during induction chemotherapy for acute myeloid leukaemia in developing countries. Posaconazole prophylaxis was associated with a significantly lower incidence of IFI. Optimal yet cost-effective strategies for prevention and early diagnosis of IFI are required to improve survival in patients undergoing chemotherapy for AML.

Mucormycosis—A clinicoepidemiological review of cases over 10 years

“…Like other studies from India, diabetes stands apart as the single most important risk factor for developing mucormycosis in our study in contrast to data from the developed countries, where haematological malignancies predominate . Outcomes of mucormycosis from haematology patients are infrequently reported in low middle income countries due to the lack of diagnostic and treatment facilities . In our study, patients with haematological conditions were typically younger with male predominance.…”

“…F I G U R E 3 Details the treatment details of the patients involved in the study from haematology patients are infrequently reported in low middle income countries due to the lack of diagnostic and treatment facilities. 12 In our study, patients with haematological conditions were typically younger with male predominance. Unlike developed countries were pulmonary mucormycosis is the commonest presentation in patients with haematological malignancies, invasive fungal sinusitis is the commonest clinical presentation in our setting.…”

“…Importantly, nephrotoxicity due to polyenes and presence of ketoacidosis were not associated with poor outcome. Brain involvement was the only significant factor for poor outcome in multivariate analysis (95% CI 4.2 [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]; P = 0.04).…”

“…Because of the significant phylogenetic variation between the various species causing mucormycosis, it is possible that they might have differing presentations and outcomes . Also the epidemiology of agents of mucormycosis may be unique in patients with haematological conditions due to the degree of immune defect . Hence, this study aims to detect possible differences in epidemiology, microbiology, clinical manifestations and treatment outcomes of culture‐proven patients with mucormycosis seen in our institution over a 10‐year period.…”

“…11 Also the epidemiology of agents of mucormycosis may be unique in patients with haematological conditions due to the degree of immune defect. 12 Hence, this study aims to detect possible differences in epidemiology, microbiology, clinical manifestations and treatment outcomes of culture-proven patients with mucormycosis seen in our institution over a 10-year period.…”