Generic placeholder image

Clinical Cancer Drugs


ISSN (Print): 2212-697X
ISSN (Online): 2212-6988

Research Article

Idarubicin and Ara-C Treatment Associated with Fungal Infection in Acute Leukemia Patients with Febrile Neutropenia

Author(s): Chinadol Wanitpongpun, Nattiya Teawtrakul, Theerin Lanamtieng, Kanchana Chansung, Chittima Sirijeerachai, Worakamol Amampai and Kittisak Sawanyawisuth*

Volume 8, Issue 2, 2021

Published on: 07 December, 2021

Article ID: e081121197783 Pages: 6

DOI: 10.2174/2212697X08666211108095152

open access plus


Background: Pateints with acute leukemia along with febrile neutropenia is at risk for fungal as well as bacterial infections. Fungal infection is a more serious and common infection in this setting, leading to a high mortality rate. There is limited data on clinical factors predictive of fungal infection in acute leukemia with febrile neutropenia.

Objective: This study aimed to evaluate clinical predictive factors of fungal infection in acute leukemia patients with FN.

Methods: This was a retrospective analytical study and included adult patients diagnosed with acute leukemia, who developed FN, and had positive culture with either bacterial or fungal infection. Predictors for fungal infection were calculated by using logistic regression analysis. A subgroup analysis in patients with acute myeloid leukemia (AML) was also performed.

Results: There were 94 patients who met the study criteria. Of those, 29 patients had positive culture for fungus (30.82%), categorized as Aspergillus (19 patients; 65.51%) and Candida (10 patients; 34.49%). The mortality rate was significantly higher in the fungal infection group than the bacterial infection group (24.14% vs. 6.15%; p 0.031). There were six factors in the final model predictive of fungal infection with one independent predictor: treatment regimen of Idarubicin plus Ara-C with an adjusted odds ratio of 5.188 (95% CI of 1.386, 19.419). A subgroup analysis for fungal infection in patients with AML showed that only the treatment regimen of Idarubicin plus Ara- C was a significant factor. Its adjusted odds ratio was 5.138 (95% CI of 1.156, 24.467).

Conclusion: Treatment with idarubicin and Ara-C may increase the risk of fungal infection in acute leukemia patients with FN.

Keywords: Aspergillosis, candidiasis, idarubicin, leukemia, neutropenia.

Graphical Abstract
Chindaprasirt J, Wanitpongpun C, Limpawattana P, et al. Mortality, length of stay, and cost associated with hospitalized adult cancer patients with febrile neutropenia. Asian Pac J Cancer Prev 2013; 14(2): 1115-9.
[] [PMID: 23621197]
Oberoi S, Das A, Trehan A, Ray P, Bansal D. Can complications in febrile neutropenia be predicted? Report from a developing country. Support Care Cancer 2017; 25(11): 3523-8.
[] [PMID: 28601903]
Calik S, Ari A, Bilgir O, et al. The relationship between mortality and microbiological parameters in febrile neutropenic patients with hematological malignancies. Saudi Med J 2018; 39(9): 878-85.
[] [PMID: 30251730]
Pagano L, Caira M, Candoni A, et al. The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica 2006; 91(8): 1068-75.
[PMID: 16885047]
Wanitpongpun C, Teawtrakul N, Lanamtieng T, et al. Clinical factors predictive of mortality in acute leukemia patients with febrile neutropenia. Am J Blood Res 2021; 11(1): 59-65.
[PMID: 33796390]
Barton CD, Waugh LK, Nielsen MJ, Paulus S. Febrile neutropenia in children treated for malignancy. J Infect 2015; 71(Suppl. 1): S27-35.
[] [PMID: 25917801]
Stoma I, Karpov I, Uss A, et al. Combination of sepsis biomarkers may indicate an invasive fungal infection in haematological patients. Biomarkers 2019; 24(4): 401-6.
[] [PMID: 30907674]
Loeffen EA, Te Poele EM, Tissing WJ, Boezen HM, de Bont ES. Very early discharge versus early discharge versus non-early discharge in children with cancer and febrile neutropenia. Cochrane Database Syst Rev 2016; 2: CD008382.
[] [PMID: 26899263]
Malagola M, Peli A, Damiani D, et al. Incidence of bacterial and fungal infections in newly diagnosed acute myeloid leukaemia patients younger than 65 yr treated with induction regimens including fludarabine: retrospective analysis of 224 cases. Eur J Haematol 2008; 81(5): 354-63.
[] [PMID: 18637030]
Pagano L, Girmenia C, Mele L, et al. Infections caused by filamentous fungi in patients with hematologic malignancies. A report of 391 cases by GIMEMA Infection Program. Haematologica 2001; 86(8): 862-70.
[PMID: 11522544]
Eggimann P, Chevrolet JC, Starobinski M, et al. Primary invasive aspergillosis of the digestive tract: report of two cases and review of the literature. Infection 2006; 34(6): 333-8.
[] [PMID: 17180588]
Okuturlar Y, Ozkalemkas F, Ener B, et al. Serum galactomannan levels in the diagnosis of invasive aspergillosis. Korean J Intern Med (Korean Assoc Intern Med) 2015; 30(6): 899-905.
[] [PMID: 26552466]
Tong T, Shen J, Xu Y. Serum galactomannan for diagnosing invasive aspergillosis in pediatric patients: A meta-analysis. Microb Pathog 2018; 118: 347-56.
[] [PMID: 29614368]

© 2024 Bentham Science Publishers | Privacy Policy