Introduction
During last years, a reduction in invasive aspergillosis (IA) incidence and mortality was observed in acute myeloid leukemia (AML) patients undergoing to induction phase of treatment. Instead, the incidence of IA and the attributable mortality rate (AMR) during the consolidation or salvage phase of chemotherapy has not been recently and extensively evaluated.
The aim of our study was to evaluate epidemiology of IA in AML patients during the consolidation and re-induction phases. All cases of proven/probable IA observed during consolidation or salvage treatment in adult and pediatric patients with AML between 2011 and 2015 were retrospectively collected in a multicenter study involving 37 Italian hematologic centers. All relevant clinical data were collected in CRFs. All cases of AI were classified according to the 2008 revised EORCT/MSG criteria.
A total of 2149 of AML patients in consolidation phase and 1439 in salvage were registered. Of these, 132 cases of AI were observed: 53 during consolidation phase and 79 during salvage treatment. Overall, the AI incidence was equal to 2,4% [13 proven (0,6%) and 40 probable (1.8%)] of patients in consolidation phase and equal to 5,4% [17 proven (1,1%) and 62 probable (4,3%)] of patients underwent salvage treatment. Two groups of patients were similar to regard age, sex, comorbidity, previous fungal infections, while significance differences were observed in genetic/cytogenetic risk groups, duration of neutropenia and steroid therapy and antifungal prophylaxis. At 120 days the overall mortality and the AMR were 0.46% and 0,19% during consolidation and 2.02% and 1.25% during salvage. Univariate analysis showed that the phase of treatment influence significantly AMR. Empiric antifungal therapy was initiated in 80 cases (65%) (mainly with L-AmB). Targeted antifungal therapy was applied in 45 cases (36%) . The most frequently targeted antifungal therapy was voriconazole. Furthermore, considering the overall population of AML patients treated in consolidation no statistical differences were observed between those receiving in induction posaconazole or other prophylaxis.
In conclusion, our study shows that the incidence of IA during the consolidation in patients with AML is low but not absent. Further studies are needed to evaluate the risk factors for AI in consolidation phase and the role of antifungal prophylaxis in this group of patients. In relapsed/refractory AML patients the AMR would seem quite low to indicate the effectiveness of diagnostic/therapeutics tools also in this group of patients with several compromised immune status.