Incidence of Invasive Fungal Infections in Adults and Pediatric Patients With Acute Lymphoblastic Leukemia Who Received Chemotherapy.

BACKGROUND: Invasive fungal infections (IFIs) are a major cause of morbidity and mortality in patients with hematologic malignancies. Despite a high infection risk, patients with acute lymphoblastic leukemia (ALL) often do not receive antifungal prophylaxis because of significant drug–drug interactions between azole antifungals and vinca alkaloids. Few studies have examined the incidence and risk factors for fungal infections in adults with ALL. OBJECTIVES: The primary objective of this study was to determine the rates of IFIs (probable and proven) in patients receiving chemotherapy for ALL. The secondary objectives included determining the incidence of invasive candidiasis, the incidence of IFIs based on the intensity of chemotherapy, the incidence of IFIs during each chemotherapy phase, the incidence of IFIs based on disease status, and the organisms involved in IFIs. METHODS: This was a single-center, retrospective cohort study of adults and pediatric patients with ALL who received chemotherapy between July 1, 2014, and June 1, 2019. The definition of IFI followed the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group 2008 criteria. The incidence rates were calculated as the number of diagnosed IFIs divided by the number of person-years at risk, which was defined as the time from the patient’s initiation of chemotherapy until the discontinuation of chemotherapy, transplant, death, or the end of follow-up. RESULTS: Of the 88 patients included in the final analysis, 4 patients had an IFI (incidence, 0.021 infections annually; 95% confidence interval, 0.057-0.53). IFIs only occurred in adults, adolescents, and young adults, and all occurred during induction chemotherapy. The organisms that were identified included Candida lusitanae, Candida dubliniensis, Cryptococcus neoformans, Blastoschizomyces capitatus, and invasive Trichophyton spp. The incidence of IFIs was higher in patients with relapsed or refractory disease than in patients with treatment-naïve ALL (12.1 vs 0.11 infections per 10 patient-years overall, respectively). CONCLUSION: The rates of IFIs were low and were similar to a previous study, which supports the current practice of not routinely using antifungal prophylaxis. The rates of IFIs may be lower in pediatric patients, because no IFIs were identified in this cohort. Further large-scale studies are required to verify our results. [ABSTRACT FROM AUTHOR]