Risk Factors for Invasive Fusariosis in Patients With Acute Myeloid Leukemia and in Hematopoietic Cell Transplant Recipients

Risk Factors for Invasive Fusariosis in Patients With Acute Myeloid Leukemia and in Hematopoietic Cell Transplant Recipients

Author Garnica, Marcia Google Scholar
Cunha, Marcos Oliveira da Google Scholar
Portugal, Rodrigo Google Scholar
Maiolino, Angelo Google Scholar
Colombo, Arnaldo L. Autor UNIFESP Google Scholar
Nucci, Marcio Google Scholar
Institution Universidade Federal do Rio de Janeiro (UFRJ)
Hosp Naval Marcilio Dias
Universidade Federal de São Paulo (UNIFESP)
Abstract Background. Risk factors for invasive fusariosis (IF) have not been characterized. We attempted to identify risk factors for IF in a prospective cohort of hematologic patients treated in 8 centers in Brazil.Methods. Patients with (cases) and without (controls) proven or probable IF diagnosed in a cohort of patients with acute myeloid leukemia (AML) or myelodysplasia (MDS), and in allogeneic hematopoietic cell transplant (HCT) recipients (early, until day 40; late, after day 40 posttransplant) were compared by univariate Cox regression analysis.Results. Among 237 induction remission courses of AML/MDS and 663 HCTs (345 allogeneic and 318 autologous), 25 cases of IF were diagnosed. in the AML/MDS cohort, active smoking (hazard ratio [HR], 9.11 [95% confidence interval {CI}, 2.04-40.71]) was associated with IF. Variables associated with IF in the early phase of allogeneic HCT were receipt of antithymocyte globulin (HR, 22.77 [95% CI, 4.85-101.34]), hyperglycemia (HR, 5.17 [95% CI, 1.40-19.11]), center 7 (HR, 5.15 [95% CI, 1.66-15.97]), and AML (HR, 4.38 [95% CI, 1.39-13.81]), and in the late phase were nonmyeloablative conditioning regimen (HR, 35.08 [95% CI, 3.90-315.27]), grade III/IV graft-vs-host disease (HR, 16.50 [95% CI, 2.67-102.28]), and previous invasive mold disease (HR, 10.65 [95% CI, 1.19-95.39]).Conclusions. Attempts to reduce the risk of IF may include smoking cessation, aggressive control of hyperglycemia, and the use of a mold-active agent as prophylaxis in patients receiving nonmyeloablative HCT or ATG in the conditioning regimen. Future research should further explore smoking and other prehospital variables as risks for IF.
Keywords invasive fusariosis
risk factor
invasive fungal disease
acute leukemia
bone marrow transplant
Language English
Date 2015-03-15
Published in Clinical Infectious Diseases. Cary: Oxford Univ Press Inc, v. 60, n. 6, p. 875-880, 2015.
ISSN 1058-4838 (Sherpa/Romeo, impact factor)
Publisher Oxford Univ Press Inc
Extent 875-880
Origin http://dx.doi.org/10.1093/cid/ciu947
Access rights Closed access
Type Article
Web of Science ID WOS:000351051600009
URI http://repositorio.unifesp.br/handle/11600/38891

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