Incidence and outcomes of invasive fungal disease in adult patients with acute lymphoblastic leukemia treated with hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone: Implications for prophylaxis

摘要

Invasive fungal disease (IFD) is a common complication of therapy for acute leukemia. Whilst the efficacy and safety of prophylactic strategies to prevent IFD during induction chemotherapy for acute myeloid leukemia are relatively well defined, very few data are available with respect to IFD incidence in adult acute lymphoblastic leukemia (ALL) [1]. Over the last decade the intensity of induction protocols in adult ALL have increased significantly [2], resulting in increased corticosteroid exposure and prolonged neutropenic episodes, both well-defined risk factors for the development of IFD [3]. Consequently, the adequacy of fluconazole-based prophylactic strategies to prevent IFD during therapy of ALL is increasingly debatable. However, due to the potential for interactions between various chemotherapy agents used in ALL induction and the extended-spectrum azoles [4,5], fluconazole continues to be used for standard IFD prophylaxis, despite its lack of anti-mold activity. More data with respect to the actual incidence and/or burden of IFD within adult ALL is needed to better define the risks and benefits of implementing anti-mold prophylaxis in this setting.