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05.06.2019 | Original Article | Ausgabe 9/2019

Supportive Care in Cancer 9/2019

High incidence of invasive fungal infection during acute myeloid leukemia treatment in a resource-limited country: clinical risk factors and treatment outcomes

Supportive Care in Cancer > Ausgabe 9/2019
Variya Nganthavee, Woraphun Phutthasakda, Kawita Atipas, Sirikul Tanpong, Teeramet Pungprasert, Dhanach Dhirachaikulpanich, Saran Krithin, Supang Tanglitanon, Warissara Jutidamronphang, Weerapat Owattanapanich, Methee Chayakulkeeree, Ployploen Phikulsod
Wichtige Hinweise
Variya Nganthavee and Woraphun Phutthasakda contributed equally to this work.
A correction to this article is available online at https://​doi.​org/​10.​1007/​s00520-019-04935-6.

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Invasive fungal infection (IFI) causes high morbidity and mortality during acute myeloid leukemia (AML) treatment. Interventions to prevent fungal infection, including air filtration systems and antifungal prophylaxis, may improve outcomes in this group of patients. However, they are expensive and therefore inapplicable in resource-limited countries. The benefit of antifungal therapy is also dependent on the local epidemiology. That led us to conduct the study to evaluate the characteristics and impact of IFI in AML patients without prophylaxis in our setting.


Clinical data from patients with AML who have been treated with chemotherapy without antifungal prophylaxis were retrieved during a 5-year period at Thailand’s hematology referral center. Incidence and risk factors of IFI and outcomes of patients were evaluated.


Among 292 chemotherapy courses, there were 65 (22.3%) episodes of IFI. Of those, 10 (15.4%) were proven, 19 (29.2%) were probable, and 36 (55.4%) were categorized as being possible IFI. Molds were the most commonly observed causative pathogens (93.1%). The incidence of probable/proven IFI was highest during first induction (20.5%), followed by second induction (6.1%), and consolidation (2.7%). A long duration of neutropenia, old age, and low serum albumin were the strongest predictors of IFI. Compared with patients who had no IFI, patients with probable/proven IFI had a longer length of hospital stay and higher in-hospital mortality. Patients with proven IFI had a significantly worse outcome at 1 year.


These results suggest the change in health policy to implement IFI preventive measures to improve outcomes of AML treatment.

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