Incidence of Invasive Fungal Infections (IFI) in Patients (pts) Receiving Hyper-CVAD. Session Type: Publication Only

Maria E. Cabanillas, Gloria N. Mattiuzzi, Mary A. Weiser, Gladys Z. Ossa, Erik G. Fowler, Sherry A. Pierce, Hagop M. Kantarjian, Guillermo Garcia-Manero, Deborah A. Thomas

Author address: 

Department of Leukemia; Department of General Internal Medicine, U.T.M.D. Anderson Cancer Center, Houston, TX, USA

Abstract: 

Background: Fungal infections are a frequent and life-threatening complication in pts with hematologic malignancies. The most serious infections occur in patients with AML/MDS and recipients of bone marrow transplants. In AML/MDS the incidence of IFI during induction is 3-8% with a mortality between 60-80%. Pts who receive hyper-CVAD chemotherapy are especially susceptible to fungal infections due to use of high dose steroids, neutropenia, and immunosuppression due to underlying malignancy. At MDACC, fluconazole 200mg daily is standard anti-fungal prophylaxis for patients undergoing hyper-CVAD for acute lymphoblastic lymphoma (ALL), lymphoblastic lymphoma (LL), or Burkitts leukemia/lymphoma (BL). Fluconazole is effective against most yeast infections but is ineffective against Candida krusei and Candida glabrata, and molds. Objectives: To determine: 1) the incidence of IFI during hyper-CVAD chemotherapy for ALL, LL, and BL while in complete remission (CR), 2) the efficacy of our standard anti-fungal prophylaxis, and 3) survival of patients with IFI. Methods: Retrospective chart review of 250 pts treated with hyper-CVAD, and who were considered to be in CR, from January 1998 until May 2003. Of the 250 pts, 83 pts have been reviewed and analyzed to date. IFI was defined as previously published by Asicoglu et al (Clin Infect Dis 2002; 34: 7-14). Since 1992 hyper-CVAD was administered as described by Kantarjian et al (JCO 18:547, 2000). From May 2000 until December 2001, the modified hyper-CVAD regimen with or without rituximab was used. This regimen incorporated a course of anthracycline intensification on course 2, and 2 courses of early and late intensification during maintenance. No maintenance was given for BL. (Thomas et al, Blood 98:590a, 2001; Cabanillas et al, J Clin Oncol 22:abstr.2309, 2003). Results: Seven of 83 were censored due to insufficient data. The incidence of episodes of IFI is as follows: proven 10.5% (8/76), probable 5.2% (4/76), and possible 9.2% (7/76). None of the pts died as a direct result of IFI. Patient Source Organism Timing of IFI Outcome 1 Blood Candida. krusei Consolidation course 7 Alive 2 Blood Candida tropicalis Induction Alive 3 Catheter tip Candida parapsilosis Consolidation course 2 Dead 4 Ascitic fluid Candida glabrata Maintenance course 3 Dead 5 Sputum Aspergillus flavus Consolidation course 5 Dead 6 Lung biopsy Aspergillus spp Induction Alive 7 Skin biopsy Fusarium spp Consolidation course 4 Alive 8 BAL Aspergillus niger Consolidation course 2 Alive Conclusion: The incidence of IFI is similar to AML/MDS, however, the mortality is lower. Prophylaxis with broad spectrum anti-fungals should be considered in pts receiving hyper-CVAD chemotherapy. The cost effectiveness, morbidity, and/or delays in treatment related to IFIs are being examined. Abstract #4688 appears in Blood, Volume 102, issue 11, November 16, 2003
2003

abstract No: 

4688

Full conference title: 

American Society of Hematology 45th Annual Meeting
    • ASH 45th (2003)