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Current smoking linked to invasive fusariosis in patients with acute myeloid leukemia
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Researchers at the Universidade Federal do Rio de Janeiro in Brazil determined that active smoking was associated with invasive fusariosis among patients undergoing induction remission for acute myeloid leukemia or myelodysplasia.
“Invasive fungal disease represents a major complication in patients with acute myeloid leukemia (AML) and in hematopoietic cell transplant (HCT) recipients,” the researchers wrote in Clinical Infectious Diseases. “While invasive aspergillosis is the most frequent invasive fungal disease in such patients, infections caused by other molds have been increasingly reported. Clinical features and prognostic factors of invasive fusariosis have been well characterized, but very little is known about risk factors.”
The researchers conducted a prospective cohort study of eight centers in Brazil to identify risk factors of invasive fusariosis among HCT recipients and individuals with AML or myelodysplasia (MDS) undergoing induction remission chemotherapy. From May 2007 to July 2009, patients undergoing HCT were followed for 1 year, and patients with AML/MDS were followed until the end of the last cycle of consolidation chemotherapy. During the study period, 218 patients with AML/MDS received 237 induction remission courses, and 650 patients underwent 663 HCTs.
Among the 900 episodes, there were 25 cases of invasive fusariosis. Among the induction courses of AML/MDS, there were eight cases: seven in the first induction remission and one in a relapsed patient. The median time from treatment initiation to invasive fusariosis diagnosis was 23.5 days, and all patients had neutropenia at diagnosis. The only significant association with invasive fusariosis in these patients was active smoking (HR=9.11; 95% CI, 2.04–40.71).
Among the HCTs, there were 17 cases of invasive fusariosis: 15 were in allogeneic HCTs and two were in autologous HCTs. Among the cases in allogeneic HCTs, 10 were diagnoses before day 40 post-transplant and five were after day 40. All cases occurring before day 40 had neutropenia, as did one case after day 40. The two cases in autologous HCT occurred in the same hospital (center 7), before 40 days, and both patients had neutropenia.
In the early post-transplant period, factors associated with invasive fusariosis included AML, center 7, receiving antithymocyte globulin, and hyperglycemia requiring insulin therapy. Factors associated with cases that developed late in the post-transplant period included a history of invasive mold disease before transplant, non-myeloablative conditioning regimens and grade III-IV graft-versus-host disease.
“The identification of these factors may help to establish a risk-based approach to prevent the occurrence of this devastating disease,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.
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