Invasive fungal infections in acute leukemia patients

Abstract

IFI is an important cause of morbidity and mortality in patients with acute leukemia. In our study, the incidence was 33.1% in 502 patients who were followed up in an inpatient ward or ICU between 2003 and 2020. It was 13.3%, when only proven and probable IFI were evaluated. Lung involvement was found to be the most, however it affected neither survival time nor death risk. According to the definition criteria established by EORTC/MSG to avoid delays in diagnosis, 32 (19.3%) patients were defined as proven, 35 (21.1%) patients as probable, and 99 (59.6%) patients as possible IFI. GM antigen test was found positive in serum in 39 (23.5%) patients and in BAL fluid in 6 (3.6%) patients. Fungal elements were demonstrated or pathogens produced in 13 (7.8%) sputum cultures and 4 (2.4%) BAL fluid cultures. BAL was applied to a total of 26 patients with IFI, and contributed to 10 proven or probable IFI diagnosis. Hereunder, BAL efficiency was determined as 38.4%. Neutropenia, ICU follow-up and undergoing MV are found to increase the risk of developing IFI by 3.5, 2.5, and 1.8 times respectively. The mean survival time was 5 (1.9-8) months. ICU follow-up is found to shorten the survival time by 12 months and increase death risk by 2.49-fold. MV administration is also found to shorten survival time by 57 months and increase death risk by 3.82-fold. As a center that provides diagnosis and treatment of patients with acute leukemia, we recommend in the IFI approach, to be aware of IFI in patients receiving intensive chemotherapy and/or recipients of haematopoietic stem cell transplantation, and to evaluate with microbiological, serological and radiological tests during the clinical follow-up.