Pagano et al identified risk factors for invasive fungal infections (IFI) in patients with acute myelogenous leukemia (AML). AML is associated with a high rate of invasive fungal infections which can be reduced by controlling risk factors. The authors are members of SEIFEM (Sorveglianza Epidemiologica Infezioni Fungine nelle Emopatie Maligne) Group in Italy.
AML-related risk factors:
(1) lower probability of complete remission (adverse cytogenetics, adverse gene mutation profile, secondary AML, WBC count > 50,000 per µL)
(2) absence of complete response by end of induction phase
(3) persistence of bone marrow blast cells on day 15
Patient-related risk factors:
(1) age > 65 years
(2) organ dysfunction with high comorbidity index
(3) poor ECOG performance status (>=2)
(4) COPD
(5) active smoking
(6) immunity polymorphism
(7) phagocytic dysfunction (AML, other)
Chemotherapy-related risk factors:
(1) highly neurotoxic regimen
(2) salvage therapy for relapsed or refractory disease
(3) mucositis Grade 3 or 4 for > 7 days, especially if involving lower gut
(4) greater toxicity of chemotherapy associated with pharmacogenetics
(5) neutropenia (based on severity and duration (ANC < 100 per µL for > 10 days greater than < 500 per µL for > 7 days)
(6) high early treatment related mortality score of Walter et al
Exposure-related risk factors:
(1) hospital room without HEPA filtration
(2) building construction or renovation
(3) high risk exposure (farming, gardening, construction work)
Fungal-related risk factors:
(1) history of Aspergillosis
(2) documented airway colonization by Aspergillus species
(3) multi-site colonization by Candida species
Profile of a patient at low risk for invasive fungal infection:
(1) age < 45 years
(2) undergoing first remission-induction or consolidation chemotherapy
(3) no risk factors for IFI
