Incidence of Invasive Fungal Infection (IFI) in ACUTE Myeloid Leukemia (AML) on Primary Prophylaxis with Voriconazole in Tertiriary Care Center in Pakistan

OBJECTIVE:

The aim of this study was to establish the incidence of IFI in AML patients receiving voriconazole prophylaxis in developing country.

METHOD:

This prospective study was conducted at The Children's Hospital, Lahore from July 2019 to December 2019 under Prospective AML registry approved by Institutional Review Board. All, consecutive patients of AML, either newly diagnosed or previously diagnosed cases with persistent fever and prolonged neutropenia, were included. Moreover, all patients of AML receiving chemotherapy also received voriconazole prophylaxis. Data of 64 patients was computed in accordance with age, gender, FAB classification, chemotherapy regimen and anti-fungal therapy. EORTC/MSG criteria was used to determine and classify IFI as proven, probable, or possible after performing CT chest and PNS, x-ray PNS, and abdominal ultrasound. CT scan was independently reviewed by a trained radiologist. Data was analyzed by SPSS version 22.

RESULTS:

Total 64 patients of AML were included in the study. The mean age of presentation was 6 years, range 1.5years to 16 years with 45 % males. Out of 64 patients, fungal infection was suspected in 50 patients (78%) due to persistent fever and prolonged neutropenia. In suspected 50 patients, probable and possible fungal infections were found in 22(34.37%) Patients. Eighteen 18/22 (81.81 %) were probable and 4/22 (18.18 %) were possible fungal infection. Majority of the cases 13/22 (59%) patients developed fungal infection during or after course of first induction therapy.

CONCLUSION:

Patients with high-risk hematologic malignancies especially AML are more at risk to develop IFI. In our study despite primary prophylaxis with voriconazole, incidence was higher than that reported in the literature from developed countries. Our data suggests that there is need to further improve supportive care measures and implement IFI preventive measures to decrease the incidence of IFI and improve survival.