Invasive fungal infection in patients receiving chemotherapy for hematological malignancy: a multicenter, prospective, observational study in China

Abstract

This stud y examined the epidemiology, risk factors, management, and outcome of invasive fungal infection (IFI) in patients receiving chemotherapy for hematological malignancy in China. IFI risk factors were analyzed using univariate analysis and multivariate logistic regression. In total, 4,192 patients receiving 4,889 chemotherapy courses were enrolled [mean age 40.7 years, 58.4% male, 16.9% children (<18 years)]. The most common hematological diseases were acute myeloid leukemia (AML, 28.5%), non-Hodgkin lymphoma (NHL, 26.3%), and acute lymphoblastic leukemia (ALL, 20.2%). Severe neutropenia (absolute neutrophil count [ANC] <500/mm(3)) occurred after one third (1,633/4,889, 33.4%) of chemotherapy courses. Incidence of proven/probable IFI was 2.1% per chemotherapy course and higher in patients with myelodysplastic syndrome (MDS, 4.94%), acute hyperleukocytic leukemia (AHL, 4.76%), AML (3.83%), or induction chemotherapy. Risk factors included ANC <500/mm(3) [odds ratio (OR) 3.60], AML or MDS (OR 1.97), induction chemotherapy (OR 2.58), previous IFI (OR 3.08), and being male (OR 1.74). Antifungal agents, prescribed in one quarter (1,211/4,889, 24.8%) of chemotherapy courses, included primary/secondary prophylaxis (n = 827, 16.9%) and/or treatment (n = 655, 13.4%; 86.9 % triazoles), which was empirical (84.3%), pre-emptive (8.6%), or targeted (7.1%). Overall mortality following each chemotherapy course (1.5%) increased in proven/probable (11.7%) and possible IFI (8.2%). In summary, IFI was more common in MDS, AHL, AML, or induction chemotherapy, and substantially increased mortality. Neutropenic patients receiving induction chemotherapy for AML or MDS and those with previous IFI were at particular risk. Antifungal prophylaxis showed an independent protective effect but was not commonly used, even in high-risk patients. By contrast, empiric antifungals were widely used.

Epidemiology and analysis of invasive fungal infections in patients withhematological malignancies: a single-center real-life experience

“…Compared to the literature, systemic antifungal usage was higher than in other studies (13.4%-17%) (7,13,16). This may be mainly related to diagnostic explication differences and local clinical conditions.…”

“…In a Japanese study, incidence of IFI was 1.3%, but IFI-attributable mortality was 36.8% (15). In the CAESAR study, incidence of IFI was 2.1% per chemotherapy course and mortality rate was 11.7% in the proven/probable IFI (16). These outcomes indicate that mortality rates remain high, although the incidence of IFI has declined in the past decade due to improved preventive strategies.…”

Epidemiology, Management, and Outcome of Invasive Fungal Disease in Patients Undergoing Hematopoietic Stem Cell Transplantation in China: A Multicenter Prospective Observational Study

“…These data suggest that, despite reductions in IFD-related deaths in the past decade 7 [5], IFD-related mortality following HSCT still approaches 50% [2,3], with higher rates among 8 recipients of allogeneic compared with autologous transplants, particularly in the presence of 9 Aspergillus infection [2,4]. As a result, HSCT recipients with suspected IFD often receive early 10 empirical therapy or pre-emptive treatment. 11 Treatment guidelines for IFD, including some that are specific to HSCT patients, have been 12 developed by academic societies in different world regions [6][7][8][9].…”

“…Subjects were consecutive patients of any age, with 25 haematological malignancy, who were hospitalised during the study period either following 26 allogeneic or autologous HSCT, or to receive intravenous chemotherapy. Overall study methods have 27 been described previously [10]. This report focuses on patients who underwent HSCT in 31 HSCT 28 centres; data from patients receiving chemotherapy have been published [10].…”

“…Overall study methods have 27 been described previously [10]. This report focuses on patients who underwent HSCT in 31 HSCT 28 centres; data from patients receiving chemotherapy have been published [10].…”