Pre-chemotherapy risk factors for invasive fungal diseases: prospective analysis of 1,192 patients with newly diagnosed acute myeloid leukemia (SEIFEM 2010-a multicenter study)

Morena Caira, Anna Candoni, Luisa Verga, Alessandro Busca, Mario Delia, Annamaria Nosari, Cecilia Caramatti, Carlo Castagnola, Chiara Cattaneo, Rosa Fanci, Anna Chierichini, Lorella Melillo, Maria Enza Mitra, Marco Picardi, Leonardo Potenza, Prassede Salutari, Nicola Vianelli, Luca Facchini, Monica Cesarini, Maria Rosaria De Paolis, Roberta Di Blasi, Francesca Farina, Adriano Venditti, Antonella Ferrari, Mariagrazia Garzia, Cristina Gasbarrino, Rosangela Invernizzi, Federica Lessi, Annunziata Manna, Bruno Martino, Gianpaolo Nadali, Massimo Offidani, Laura Paris, Vincenzo Pavone, Giuseppe Rossi, Antonio Spadea, Giorgina Specchia, Enrico Maria Trecarichi, Adriana Vacca, Simone Cesaro, Vincenzo Perriello, Franco Aversa, Mario Tumbarello, Livio Pagano

Correct definition of the level of risk of invasive fungal infections is the first step in improving the targeting of preventive strategies. We investigated the potential relationship between pre-hospitalization exposure to sources of fungi and the development of invasive fungal infections in adult patients with newly diagnosed acute myeloid leukemia after their first course of chemotherapy. From January 2010 to April 2012, all consecutive acute myeloid leukemia patients in 33 Italian centers were prospectively registered. Upon first admission, information about possible pre-chemotherapy risk factors and environmental exposure was collected. We recorded data regarding comorbid conditions, employment, hygienic habits, working and living environment, personal habits, hobbies, and pets. All invasive fungal infections occurring within 30 days after the first course of chemotherapy were recorded. Of the 1,192 patients enrolled in this study, 881 received intensive chemotherapy and were included in the present analysis. Of these, 214 developed an invasive fungal infection, including 77 proven/probable cases (8.7%). Of these 77 cases, 54 were proven/probable invasive mold infections (6.1%) and 23 were proven yeast infections (2.6%). Upon univariate analysis, a significant association was found between invasive mold infections and age, performance status, diabetes, chronic obstructive pulmonary disease, smoking, cocaine use, job, hobbies, and a recent house renovation. Higher body weight resulted in a reduced risk of invasive mold infections. Multivariate analysis confirmed the role of performance status, job, body weight, chronic obstructive pulmonary disease, and house renovation. In conclusion, several hospital-independent variables could potentially influence the onset of invasive mold infections in patients with acute myeloid leukemia. Investigation of these factors upon first admission may help to define a patient's risk category and improve targeted prophylactic strategies.