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Invasive aspergillosis in relapsed/refractory acute myeloid leukemia patients. Results from SEIFEM 2016-B survey.

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BACKGROUND In patients with relapsed/refractory acute myeloid leukemia (R/R AML) who received salvage chemotherapy, limited and not updated studies explored the incidence of invasive aspergillosis (IA) and the role of… Click to show full abstract

BACKGROUND In patients with relapsed/refractory acute myeloid leukemia (R/R AML) who received salvage chemotherapy, limited and not updated studies explored the incidence of invasive aspergillosis (IA) and the role of antifungal prophylaxis (AP). The aims of this multicenter retrospective "SEIFEM 2016 B" study were: 1) to evaluate the current rate and the outcome of proven/probable IA and 2) to assess the efficacy of AP, in a large "real life" series of patient with R/R AML submitted to salvage chemotherapy. RESULTS Of 2250 R/R AML patients, a total of 74 cases of IA (5.1%) were recorded: 10 (0.7%) proven and 64 (4.3%) probable. Information about AP were available in 73/74 (99%) patients. Fifty-eight (79%) breakthrough infections occurred, mainly during AP with posaconazole [25 (43%)]. The patients who received AP during salvage chemotherapy showed a benefit from antifungal therapy (AT) than patients who didn't received AP [43(86%) vs 7(14%); p<.033]. In a multivariate analysis, AP and absence of severe mucositis had a significant favorable effect on overall response rate. CONCLUSION Our data demonstrated that the incidence of IA during the salvage chemotherapy is similar to the past. Nevertheless, the attributable mortality rate (AMR) appears to be lower than that previously reported in R/R AML. Further prospective studies should be performed to confirm our preliminary observation and understand and the why a decreased AMR is reported in this setting of high-risk patients.

Keywords: relapsed refractory; salvage chemotherapy; refractory acute; myeloid leukemia; invasive aspergillosis; acute myeloid

Journal Title: Mycoses
Year Published: 2021

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