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Systemic antifungal prophlaxis reduces invasive fungal in acute myelogenous leukemia: a retrospective review of 833 episodes of neutropenia in 322 adults

Leukemia volume 16, pages 1197–1199 (2002)Cite this article

Although antifungal prophylaxis is thought to reduce invasive fungal infections in at least some neutropenic patients,1 limited data exists on its utility in adults receiving chemotherapy for acute myelogenous leukemia (AML). Despite the lack of focused data on its utility in AML, prophylaxis is now commonly used. As the available large studies report patients with a mixture of underlying types of leukemia, we have retrospectively examined the impact of antifungal prophylaxis in a large consecutive series of adults with AML. To evaluate simultaneously a control population that did not receive prophylaxis, we reviewed the medical records, mycological reports and autopsy reports of patients 14 years of age or older treated at the University of Texas MD Anderson Cancer Center for AML from January 1988 to December 1992. As noted below, this period spans the introduction of fluconazole and a local change in practice towards extensive use of antifungal prophylaxis. Only patients who received remission-induction chemotherapy were eligible. Patients were excluded if they had received systemic antifungal therapy or had documented fungal or mould infection within the month prior to study entry or if they had Aspergillus colonization of the nasal cavity.

Three hundred and thirty-one patients with 974 episodes of neutropenia met enrolment criteria. Of these, complete records were available on 851 episodes of neutropenia in 322 patients. After excluding 18 episodes of neutropenia because of an invasive fungal infection during a prior episode of neutropenia, 833 episodes of neutropenia in 322 patients remained. These episodes of neutropenia spanned two significant time frames. Between January 1988 and December 1990 there were 453 qualifying episodes of neutropenia in 186 patients. Fluconazole was largely unavailable during this time, a systemic antifungal agent was given in only 174 (38%) of episodes, and that agent was amphotericin B (49%), fluconazole (34%) and other agents (17%). However, systemic antifungal prophylaxis was given during 305 (80%) of the 380 episodes of neutropenia in 151 patients that occurred after January 1991 (15 patients had episodes both before and after December 1990) and was fluconazole in 304 (99.7%) of episodes. Other than 90 patients who were randomized to receive either fluconazole or amphotericin B prophylaxis between May 1989 and December 1990,2 the decision to give prophylaxis during either time frame was at the discretion of the attending physician.

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Author notes

  1. EJ Anaissie

    Present address: The Myeloma and Transplantation Research Center, University of Arkansas for Medical Sciences, Little Rock, 77205, Arkansas, USA

Authors and Affiliations

  1. Division of Infectious Diseases, Department of Internal Medicine, Center for the Study of Emerging and Reemerging Pathogens, University of Texas Medical School, Houston, TX, USA

    JH Rex

  2. The Myeloma and Transplantation Research Center, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    EJ Anaissie

  3. 2nd Department of Internal Medicine, Athens University, Greece

    E Boutati

  4. Department of Leukemia, MD Anderson Cancer Center, Houston, TX, USA

    E Estey & H Kantarjian

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Rex, J., Anaissie, E., Boutati, E. et al. Systemic antifungal prophlaxis reduces invasive fungal in acute myelogenous leukemia: a retrospective review of 833 episodes of neutropenia in 322 adults. Leukemia 16, 1197–1199 (2002). https://doi.org/10.1038/sj.leu.2402495

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