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Risk of invasive fungal infections in patients with high‐risk MDS and AML receiving hypomethylating agents
Author(s) -
Kim Gee Youn Geeny,
Burns Jonathan,
Freyer Craig W.,
Hamilton Keith W.,
Frey Noelle V.,
Gill Saar I.,
Hexner Elizabeth O.,
Luger Selina M.,
Mangan James K.,
Martin Mary E.,
McCurdy Shan R.,
Perl Alexander E.,
Porter David L.,
Schuster Mindy G.,
Stadtmauer Edward A.,
Loren Alison W.
Publication year - 2020
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.25808
Subject(s) - medicine , incidence (geometry) , myelodysplastic syndromes , azacitidine , myeloid leukemia , hypomethylating agent , population , oncology , biology , bone marrow , biochemistry , gene expression , physics , environmental health , optics , dna methylation , gene
Invasive fungal infections (IFI) are a significant source of morbidity and mortality for patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). Given the heterogeneity of the population receiving hypomethylating agents (HMA), it is difficult for clinicians to accurately assess their patients' risk of infection. Literature on the incidence of IFI following HMA is limited to several studies of azacitidine. The primary objective of this retrospective study was to establish the incidence of IFI in HMA treated AML/MDS patients at a large U.S. comprehensive cancer center. Secondary objectives included comparing incidence of IFI among pre‐specified subgroups to identify potential risk factors for IFI. Two hundred three patients with AML, intermediate to very high risk MDS or chronic myelomonocytic leukemia who received at least two cycles of HMA were included. The incidence of IFI, as defined by the European Organization for Research and Treatment of Cancer / Invasive Fungal Infections Cooperative Group criteria, was 9.6%, with 20 IFI diagnosed following HMA (three proven, four probable, 13 possible). Among the proven cases of IFI, molds included Scedosporium and Fusarium spp. Eleven patients who developed IFIs were neutropenic upon initiating HMA. The majority (17/20) of infections occurred during the first four cycles. Given this incidence, mold‐active prophylaxis can be considered in patients who are neutropenic at the start of therapy.