Clinical risk factors for development of invasive aspergillosis prior to stem cell transplantation in patients receiving treatment for acute myeloid leukaemia.

Ref ID: 19181

Author:

R.J. van de Peppel*, O.M. Dekkers, P.A. von dem Borne, M.G.J. de Boer

Author address:

Leiden, NL

Full conference title:

23rd European Congress of Clinical Microbiology and
Infectious Diseases

Date: 27 April 2014

Abstract:

Background: Due to both disease factors and intensive chemotherapy, patients diagnosed with acute myeloid leukemia (AML) are at risk for invasive aspergillosis (IA) even prior to the event of stem cell transplantation (SCT). In times of emerging triazole resistance and changing approaches towards use of antifungal prophylaxis, insight in clinical risk factors prior to SCT can improve strategies to prevent or early detect IA in this population.
Methods: All consecutive patients from one academic referral center who received >=1 course of remission-induction therapy for AML between January 1st 2005 and December 31st 2011 were included in a retrospective cohort study. Instead of standard primary prophylaxis against filamentous fungi, an assertive diagnostic protocol was in place for detection of suspected pulmonary fungal infection. IA was classified according to the revised EORTC-criteria. For all patients, clinical data were extracted from electronic patient files. Clinical characteristics were compared between patients with and without a diagnosis of IA during the period of receiving intensive chemotherapy prior to SCT by uni- and multivariate logistic regression analyses.
Results: Forty-nine (32%) of 154 included patients were diagnosed with IA before SCT (4% proven, 61% probable and 35% possible IA). Univariate analysis showed that a history of lung disease (RR 1.8 95%CI 1.1-2.9), secondary AML (RR 2.7 95%CI 1.8-4.0), relapsed AML (RR 2.0 95%CI 1.3-3.1), >60 days of neutropenia (RR 1.8 95%CI 1.2-2.8) and the total number of days with neutropenia are associated with occurrence of IA. Receipt of granulocyte colony-stimulating factor (GCSF) conveyed a decreased risk of development of IA (RR 0.4 95%CI 0.2-1.0). Notably, age, sex and cytogenetic abnormalities that define subtypes of AML were not found to be associated with occurrence of IA. Multivariate analysis demonstrated secondary AML (RR 13.2 95%CI 3.0-57, p=0.001), relapsed AML (RR 3.5 95%CI 1.4-8.9, p=0.007) and >60 days of neutropenia (RR 2.6 95%CI 1.1-5.8, p=0.02) as independent risk factors. Use of GCSF remained a protective indicator (RR 0.2 95% 0.06-0.79, p=0.02).
Conclusions: The results provide a set of independent clinical risk factors (i.e., relapsed AML, secondary AML and prolonged neutropenia) that are either present at baseline or develop during therapy and may guide further development of more individualized prophylactic strategies to effectively prevent IA in patients treated for AML.

Abstract Number: P1050

Conference Year: 2013

Link to conference website: http://registration.akm.ch/einsicht.php?XNABSTRACT_ID=163978&XNSPRACHE_ID=2&XNKONGRESS_ID=180&XNMASK

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