TABLE 1

Candidate risk factors for documented IFI in patients with AML during first 120 days after first remission-induction chemotherapy

DemographicpDocumented IFI (n = 21)No IFI (n = 104)P valuea
Male, n (%)7 (33)62 (60)0.05
Median age (IQR), yrs63 (57–70)65 (51–73)0.7
Hospitalizationb0.11
    Median no. of hospitalizations (IQR)1 (1–1)2 (1–3)
    Median duration (IQR), days21 (14–29)31 (22–39)
Admission to the HEPA filter room, n (%)8 (38)35 (34)0.7
Underlying conditions,c n (%)
    Lung disease or infectiond5 (24)26 (25)0.95
    Concomitant bacterial infectione5 (24)15 (14)0.3
    Cardiovascular disease or condition8 (38)32 (31)0.46
    Diabetes mellitus or hyperglycemiaf5 (24)18 (17)0.57
    History of renal failure or renal dysfunctiong1 (5)15 (14)0.23
    Abnormal liver testsh2 (10)13 (13)0.76
No. (%) with other malignancyi7 (33)19 (18)0.13
No. (%) chemotherapy naive16/21 (80)94/103 (91)0.04
WHO AML classification,j n (%)
    Therapy-related AML4/21 (19)4/102 (4)0.03
    MDS-related changes8/21 (38)29/102 (28)0.46
    Recurrent genetic abnormalities5/21 (24)20/102 (20)0.71
    Myeloid sarcoma0/21 (0)3/102 (3)0.31
    Acute leukemia of ambiguous lineage0/21 (0)2/102 (2)0.37
    Not specified4/21 (19)44/102 (43)0.07
Cytogenetic risk group,k n (%)
    Favorable5 (24)19 (18)0.58
    Intermediate I1 (5)9 (9)0.65
    Intermediate II7 (33)30 (29)0.32
    Adverse8 (38)46 (44)0.41
Remission-induction chemotherapy, n (%)
    Cytarabine-based regimen16 (76)77 (74)0.82
    Other regimen5 (24)27 (26)0.99
    Investigational chemotherapyl14 (67)37 (36)0.10
    Clofarabine-based regimenm10 (48)19 (18)0.006
Overall remission0.3
    Overall remission, n (%)n4 (19)71 (68)
Neutropenia0.12
    Neutropenia at start of prophylaxis, n (%)12 (57)54 (52)
    Median no. of episodes of neutropenia (IQR)1 (1–2)3 (1–4)
    Median duration of neutropenia (IQR), dayso23 (16–31)47 (28–70)
Primary antifungal prophylaxis
    Anti-Aspergillus azole (voriconazole or posaconazole)0.009
        Anti-Aspergillus azole use, n (%)10 (48)77 (74)
        Median duration of anti-Aspergillus azoles (days), IQR19 (13–25)75 (29–101)
    Fluconazole0.4
        Fluconazole use, n (%)7 (33)40 (38)
        Median duration of fluconazole (days), IQR5 (2–35)31 (7–80)
    Echinocandin0.002
        Echinocandin use, n (%)17 (81)66 (63)
        Median duration of echinocandins (days), IQR11 (7–21)17 (9–28)
  • a Univariate Cox regression analysis.

  • b Time-dependent variable.

  • c At-hospital admission or history.

  • d Lung infection at hospital admission or concomitant to AML history.

  • e At-hospital admission or concomitant to AML history according to the patient's treating physician based on clinical, microbiology, and antibiotic prescription data.

  • f Diagnosis of diabetes mellitus or induced hyperglycemia (glucose ≥ 200 mg/dl).

  • g Diagnosis of renal failure or a 50% increase in serum creatinine level.

  • h Diagnosis of liver disease or abnormal liver blood tests (serum alanine aminotransferase and/or aspartate aminotransferase levels > 3.0 × upper limit of normality [ULN] and/or total bilirubin > 1.5 × ULN).

  • i Solid cancers in breast (9 patients), skin (7), prostate (4), parotid (2), thyroid (1), vocal cord (1), and cervix uteri (1); chronic myelomonocytic leukemia (2); acute lymphoblastic leukemia (1); Hodgkin's lymphoma (1); not specified (3).

  • j Data are from Vardiman et al. (20).

  • k Data are from Estey (21).

  • l Eleven investigational chemotherapy protocols.

  • m Three investigational clofarabine-containing protocols in FRIC: (i) clofarabine plus low-dose cytarabine followed by consolidation of clofarabine plus low-dose cytarabine alternating with decitabine in frontline AML and high-risk MDS (n = 20 patients); (ii) clofarabine, idarubicin, and cytarabine combination as induction therapy for younger patients with AML (n = 7 patients); (iii) phase I/II study of plerixafor and clofarabine in previously untreated older (≥60 years of age) adult patients with AML with two or more unfavorable prognostic factors for whom standard induction chemotherapy is unlikely to be of benefit (n = 2 patients).

  • n Overall remission as described by Faderl et al. (9).

  • o Considering all episodes of neutropenia.

  • p HEPA, high-efficiency particulate air; MDS, myelodysplastic syndrome.