Invasive fungal diseases in patients with new diagnosed acute lymphoblastic leukaemia

• Published in: Mycoses Vol. 63; no. 10; pp. 1101 - 1106
• Main Authors: Gründahl, Marie, Wacker, Beate, Einsele, Hermann, Heinz, Werner J.
• Format: Journal Article
• Language: English
• Published: Berlin Wiley Subscription Services, Inc 01-10-2020
• Subjects: acute lymphoblastic leukaemia; Acute lymphoblastic leukemia; Acute myeloid leukemia; Fungal diseases; fungal infection; Fungal infections; galactomannan; incidence; Invasiveness; Leukemia; mortality; Neutropenia; Patients; Prophylaxis
• ISSN: 0933-7407; 1439-0507
• DOI: 10.1111/myc.13151

Summary
Background
Patients with acute leukaemia have a high incidence of fungal infections. This has primarily been shown in acute myeloid leukaemia and is different for acute lymphoblastic leukaemia. Until now no benefit of mould active prophylaxis has been demonstrated in the latter population.
Methods
In this retrospective single‐centre study, we analysed the incidence, clinical relevance, and outcome of invasive fungal diseases (IFD) as well as the impact of antifungal prophylaxis for the first 100 days following the primary diagnosis of acute lymphoblastic leukaemia.
Results
In 58 patients a high rate of proven, probable, and possible fungal infections could be demonstrated with a 3.4%, 8.6%, and 17.2% likelihood, respectively. The incidence might be even higher, as nearly 40% of all patients had no prolonged neutropenia for more than 10 days, excluding those from the European Organization of Research and Treatment of cancer and the Mycoses Study Group criteria for probable invasive fungal disease. The diagnosed fungal diseases had an impact on the duration of hospitalisation, which was 13 days longer for patients with proven/probable IFD compared to patients with no signs of fungal infection. Use of antifungal prophylaxis did not significantly affect the risk of fungal infection.
Conclusion
Patients with acute lymphoblastic leukaemia are at high risk of acquiring an invasive fungal disease. Appropriate criteria to define fungal infections, especially in this population, and strategies to reduce the risk of infection, including antifungal prophylaxis, need to be further evaluated.