Invasive fungal infections in adult patients with acute leukemia: A 2–year prospective observational study at a tertiary care cancer centre in South India.

K. Govind Babu; Gita R Bhat

Volume : VII, Issue : IX, September - 2017

Invasive fungal infections in adult patients with acute leukemia: A 2–year prospective observational study at a tertiary care cancer centre in South India.

K. Govind Babu, Gita R Bhat

Abstract :

Objectives:

Invasive fungal infections (IFIs) are important causes of treatment failure and death in acute leukemia. Candida and Aspergillus are the common pathogens. Conventional amphotericin–B deoxycholate (AmB) has been the mainstay of treatment. Newer formulations such as liposomal amphotericin–B (LAmB), amphotericin–B lipid complex, echinocandins and triazoles are less toxic and have a oader spectrum of activity.

Our aim was to study the spectrum of IFIs in adults with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) and efficacy and safety of firstline AmB.

Materials and methods:

This single centre, prospective, observational study conducted over two years (2013– 2015) had 123 adults (58 with ALL and 65 with AML).

Results:

Out of 178 courses of chemotherapy administered during the study period, 98 (55%) of all–category IFIs were identified. 26.4% (47/178) were during induction therapy for AML.As invasive interventions were withheld due to severe thrombocytopenia and neutropenia, majority of IFIs were classified as possible (30.9%), most common sites were bloodstream and lung. There was one probable (pulmonary aspergillosis) and three proven IFIs (candidemia–2 and T.asahii – 1). IFIs were an important cause of induction mortality (40% in ALL and AML). Baseline neutropenia, relapsed–refractory diseases were important pre–treatment risk factors associated with the incidence of IFIs. Prolonged and severe neutropenia was an important post–treatment risk factor. AmB was the firstline antifungal agent used in 96 episodes. Only 9 patients switched over to 2^nd line agents (voriconazole –5 and caspofungin– 4). The most common adverse effect of AmB was hypokalemia (CTCAE Grade1 and 3) (6.9%) followed by infusion–related reactions (Grade 2) (34.4%) and reversible renal impairment (Grade 2) (2.1%).

Conclusion:

IFIs are important causes of morbidity and mortality in acute leukemia especially during intensive induction therapy and in relapsed–refractory disease. AmB is a reasonable firstline agent with manageable toxicities. Use of 2^nd line antifungals on the basis of pre– and post–treatment risk factors will improve outcomes.