Risk factors for invasive fusariosis in patients with acute myeloid leukemia and in hematopoietic cell transplant recipients.

BACKGROUND: Risk factors for invasive fusariosis (IF) have not been characterized. We attempted to identify risk factors for IF in a prospective cohort of hematologic patients treated in 8 centers in Brazil.

METHODS: Patients with (cases) and without (controls) proven or probable IF diagnosed in a cohort of patients with acute myeloid leukemia (AML) or myelodysplasia (MDS), and in allogeneic hematopoietic cell transplant (HCT) recipients (early, until day 40; late, after day 40 posttransplant) were compared by univariate Cox regression analysis.

RESULTS: Among 237 induction remission courses of AML/MDS and 663 HCTs (345 allogeneic and 318 autologous), 25 cases of IF were diagnosed. In the AML/MDS cohort, active smoking (hazard ratio [HR], 9.11 [95% confidence interval {CI}, 2.04-40.71]) was associated with IF. Variables associated with IF in the early phase of allogeneic HCT were receipt of antithymocyte globulin (HR, 22.77 [95% CI, 4.85-101.34]), hyperglycemia (HR, 5.17 [95% CI, 1.40-19.11]), center 7 (HR, 5.15 [95% CI, 1.66-15.97]), and AML (HR, 4.38 [95% CI, 1.39-13.81]), and in the late phase were nonmyeloablative conditioning regimen (HR, 35.08 [95% CI, 3.90-315.27]), grade III/IV graft-vs-host disease (HR, 16.50 [95% CI, 2.67-102.28]), and previous invasive mold disease (HR, 10.65 [95% CI, 1.19-95.39]).

CONCLUSIONS: Attempts to reduce the risk of IF may include smoking cessation, aggressive control of hyperglycemia, and the use of a mold-active agent as prophylaxis in patients receiving nonmyeloablative HCT or ATG in the conditioning regimen. Future research should further explore smoking and other prehospital variables as risks for IF.