scholarly journals Prevalence and predictors of pulmonary fungal infections in patients with acute leukemia and aggressive lymphomas: Implications for cancer care in developing countries

2021 ◽  
Vol 0 ◽  
pp. 1-7
Author(s):  
Adaeze Chikaodinaka Ayuk ◽  
Eno Ekop ◽  
Oluwatobi Ozoya ◽  
Odunayo Lawal ◽  
Josephine Emole
Keyword(s):  
Native American ◽  
Acute Leukemia ◽  
Charlson Comorbidity Index ◽  
Fungal Infections ◽  
The United States ◽  
Antifungal Prophylaxis ◽  
Aggressive Lymphoma ◽  
Aggressive Lymphomas ◽  
Comorbidity Index ◽  
Pulmonary Fungal Infections

Objectives: Among patients receiving cancer therapy, pulmonary fungal infections (PFIs) are an important cause of morbidity and mortality. Identifying predictors of PFI can direct targeted prophylaxis to improve outcomes, especially in low- and middle-income countries (LMIC) with limited resources. The objectives of the study were to evaluate the predictors of PFI in hospitalized patients with hematological malignancies in the United States and implications for prioritizing anti-fungal care in LMIC. Materials and Methods: Using the 2018 National Inpatient Sample, we conducted a retrospective study of patients ≥18 years, with acute leukemia or aggressive lymphoma. Demographics and outcomes were compared between patients with and without PFI. Predictors of PFI were evaluated by regression analysis. Results: PFI was diagnosed in 1635 (0.8%) of 205,525 eligible hospitalizations and aspergillosis was noted in 1315 (80.4%) of PFI cases. Patients with acute myeloid leukemia (AML) accounted for 64.2% of cases of PFI. Patients with PFI, when compared with those without PFI, were younger, had higher Charlson comorbidity index, were more likely to be non-Caucasian, and to have AML. Patients with PFI had higher odds of respiratory failure, sepsis, and in-hospital mortality. Variables associated with PFI were Hispanic or native American origin (OR = 1.71; 95% CI: 1.21–2.42), Charlson comorbidity index ≥3 (OR = 1.52; 95% CI: 1.16–2.00), neutropenia (OR = 1.97; 95% CI: 1.58–2.46), malnutrition (OR = 2.30; 95% CI: 1.75–3.01), bone marrow transplant status (OR = 2.28, 95% CI: 1.53–3.39), and AML diagnosis (OR = 3.12; 95% CI: 2.40–4.05). Conclusions: This study identified variables associated with PFI in patients diagnosed with acute leukemia and aggressive lymphomas. In LMIC, where resources are scarce, patients with cancer who have the identified high-risk characteristics should be given priority for antifungal prophylaxis.

Pulmonary fungal infections in acute leukemias and aggressive lymphomas: Analysis of the United States National Inpatient Database.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19042-e19042
Author(s):  
Oluwatobi Ozoya ◽  
Adaeze Ayuk ◽  
Odunayo Lawal ◽  
Josephine Emole
Keyword(s):  
Native American ◽  
High Risk ◽  
Fungal Infections ◽  
The United States ◽  
Marrow Transplant ◽  
Antifungal Prophylaxis ◽  
Therapeutic Drug ◽  
Acute Leukemias ◽  
Aggressive Lymphomas ◽  
Pulmonary Fungal Infections

e19042 Background: For patients undergoing intensive chemotherapy, pulmonary fungal infections (PFI) represent a major cause of morbidity and mortality. Our study examined predictors and outcomes of PFI in hospitalized patients (pts) with hematological malignancies in the current era of antifungal prophylaxis for high-risk patients. Methods: Using the 2018 National Inpatient Sample (NIS) database, we conducted a retrospective study of hospitalized pts aged ≥ 18 years, with acute leukemias or aggressive lymphomas. Hospitalizations were selected using International Classification of Disease, Tenth Revision (ICD-10) codes for leukemias, lymphomas and PFI (candidiasis, aspergillosis, cryptococcus, and mucormycosis). Demographics, comorbidities, and outcomes were compared between pts with and without PFI using Chi-squared test. Multivariable logistic regression was performed to explore predictors associated with PFI. Results: Of 205,525 hospitalizations that met the inclusion criteria, PFI was diagnosed in 1635 (0.8%). Frequent infections were aspergillosis (80%) and candidiasis (11%). Pts with acute myeloid leukemia (AML) accounted for 64% of all PFI. The PFI group, compared to non-PFI, were more likely to be non-Caucasian (39% vs 32%, p<0.05), have higher Charlson comorbidity index (CI) [64% vs 55%, p<0.01], longer mean length of stay (23 vs 9 days, p<0.001), and more likely to have AML (64% vs 33%, p<0.001). Pts with PFI had higher odds of acute respiratory failure, severe sepsis, and in-hospital mortality. Mortality rates for PFI and non-PFI group were 17% and 6% respectively (p<0.001). Predictors associated with PFI were Hispanic or Native American race, Charlson CI ≥ 3, neutropenia, malnutrition, bone marrow transplant status and diagnosis of AML (Table). Conclusions: Our study identified clinical variables that predicted for PFI in patients with acute leukemias and aggressive lymphomas. Pts with these high-risk characteristics should get priority for close surveillance, mold-specific prophylaxis, and antifungal therapeutic drug monitoring. Selected predictors associated with pulmonary fungal infections. Adjusted Odds ratio (OR).[Table: see text]

scholarly journals Racial and Ethnic Enrollment Disparities and Demographic Reporting Requirements in Acute Leukemia Clinical Trials

2021 ◽  
Author(s):  
Andrew Hantel ◽  
Marlise R. Luskin ◽  
Jacqueline S Garcia ◽  
Wendy Stock ◽  
Daniel J DeAngelo ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Native American ◽  
Acute Leukemia ◽  
Race And Ethnicity ◽  
Disease Incidence ◽  
The United States ◽  
Reporting Requirements ◽  
Number Of Patients ◽  
Hispanic Patients ◽  
Race Ethnicity

Data regarding racial and ethnic enrollment diversity for acute myeloid (AML) and lymphoid leukemia (ALL) clinical trials in the United States (US) are limited, and little is known about the effect of federal reporting requirements instituted in the late 2000s. We examined demographic data reporting and enrollment diversity for US ALL and AML trials from 2002-2017 as well as changes in reporting and diversity after reporting requirements were instituted. Of 223 AML and 97 ALL trials with results, 68 (30.5%) and 51 (52.6%) reported enrollment by both race and ethnicity. Among trials that reported race and ethnicity (AML N=6,554; ALL N=4,149), non-Hispanic (NH)-Black, NH-Native American, NH-Asian, and Hispanic patients had significantly lower enrollment compared to NH-white patients after adjusting for race-ethnic disease incidence (AML odds: 0.68, 0.31, 0.75, and 0.83; ALL: 0.74, 0.27, 0.67, and 0.64; all p≤0.01). The proportion of trials reporting race increased significantly after the reporting requirements (44.2 to 60.2%; p=0.02), but race-ethnicity reporting did not (34.8 to 38.6%; p=0.57). Reporting proportions by number of patients enrolled increased significantly after the reporting requirements (race: 51.7 to 72.7%, race-ethnicity: 39.5 to 45.4%; both p&lt;0.001), and relative enrollment of NH-Black and Hispanic patients decreased (AML odds: 0.79 and 0.77; ALL: 0.35 and 0.25; both p≤0.01). These data suggest that demographic enrollment reporting for acute leukemia trials is suboptimal, changes in diversity after the reporting requirements may be due to additional enrollment disparities that were previously unreported, and enrollment diversification strategies specific to acute leukemia care delivery are needed.

Caspofungin Primary Antifungal Prophylaxis in Acute Leukemia Patients During Induction Therapy: Results of a Prospective Phase II Multicentric Study (ProfilC Study).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1638-1638
Author(s):  
Chiara Cattaneo ◽  
Simona Monte ◽  
Alessandra Algarotti ◽  
Ernesta Audisio ◽  
Erika Borlenghi ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Leukemia ◽  
Induction Therapy ◽  
Fungal Infections ◽  
Lymphoblastic Leukemia ◽  
Antifungal Prophylaxis ◽  
Blood Levels ◽  
Predictive Tool ◽  
Who Grade ◽  
Multicentric Study

Abstract Abstract 1638 Poster Board I-664 Background The need for antifungal prophylaxis in acute leukemia (AL) is a very debated topic, considering its potential of inducing resistant strains and of impairing detection of Aspergillus antigen as well as cost-efficacy balance. Targeted prophylaxis, focused on patients (pts) with high risk diseases (e.g. AL during induction therapy), seems to be the most promising strategy. Caspofungin is a well-tolerated echinocandin, with a different mechanism of action with respect to azoles and amphotericin B. Pentraxin 3 (PTX3) belongs to the superfamily of pentraxins acute-phase reactants and may play a protective role against Aspergillus spp (Garlanda et al, Nature 2002). Aims To determine the incidence of invasive fungal infections (IFIs) and invasive aspergillosis (IA), the efficacy and safety of caspofungin as primary antifungal prophylaxis during AL induction and to evaluate PTX3 levels as in vivo predictive tool for IFI development. Patients and Methods From Jan-07 to Jan-09, the incidence of IFIs and IA during induction was evaluated among all pts with acute lymphoblastic leukemia (ALL) and acute myeloblastic leukemia (AML) registered in NILG (Northern Italy Leukemia Group) protocols. Ninety-three pts entered the prospective ProfilC protocol and received Caspofungin prophylaxis (70 mg i.v. d1, then 50 mg i.v./d till leukemia remission). ProfilC epidemiological data were compared with those observed among 82 pts not assigned to ProfilC and treated according to the standard prophylactic (SP) policy adopted by each center (67 itraconazole, 10 fluconazole, 1 posaconazole, 4 no prophylaxis). PTX3 blood levels could be evaluated in 90 pts. Results Considering all 175 pts, M/F ratio was 103/72, median age was 50 (range 18-73); AML/ALL ratio was 138/37. Overall 32 IFIs (18.3%) were observed, 10 probable/proven (5.7%) (8 IA, 1 Candida spp and 1 G. capitatum bacteremias) and 22 possible (12.6%) according to EORTC/MSG criteria. IFIs (probable/proven and possible) were more frequent in AML (6.5% and 14.5%) than ALL (2.7% and 5.4%). Probable/proven IAs were not seen in ALL. The incidence of probable/proven or possible IFIs between ProfilC pts and those treated with SP was 7.5% and 9.7% vs 3.7% and 15.9%, respectively. Specifically, probable/proven or possible IAs were 5.4% and 8.6% in ProfilC group and 3.7% and 14.6% in SP group, respectively. These data show a lower, albeit not statistically significantly, incidence of IFI and IA in ProfilC pts. Fifteen out of the 175 (8.6%) pts died (ProfilC: 9.7%, SP: 7.3%, p=ns) with only one death due to IFI (G. capitatum sepsis). None of the 8 pts with IA died. Five pts experienced WHO grade >2 toxicity (3 hepatic, 1 skin, 1 hepatic and renal), 3 receiving Caspofungin and 2 itraconazole. One of the 5 pts died (itraconazole) of hepato-renal failure. A trend towards an association between lower PTX3 levels and IFI development was shown, since 13.8% of pts with PTX3 levels >10 ng/ml had IFI (probable: 3.4%), compared to 27.8% of those with '10 ng/ml (probable 8.2%). Conclusions Anti-Aspergillus oriented prophylaxis in AL pts was standard policy at most NILG centers. The incidence and letality of probable/proven IFIs and IA were lower than expected and reported by others. Given this epidemiological scenario, the superiority of one drug with respect to others is difficult to demonstrate. Caspofungin was well tolerated during induction and was at least as effective as other prophylactic agents. It may be particularly suited for AL pts with impaired intestinal absorption. High levels of PTX3 (>10 ng/ml) could be protective against IFI/IA, suggesting that PTX3 could be used to identify a very high risk pts population in which an intensified strategy of prophylaxis may be worth testing. Disclosures Off Label Use: Caspofungin as antifungal prophylaxis. Rossi:Merck Sharp & Dohme: Membership on an entity's Board of Directors or advisory committees.

Evaluation for the Need of Antifungal Prophylaxis In High Risk Hematologic Patients.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4547-4547
Author(s):  
Olga Pérez ◽  
Manuela Aguilar ◽  
Almudena Martín ◽  
Jose Falantes ◽  
Isabel Montero ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Acute Leukemia ◽  
Cord Blood ◽  
Umbilical Cord Blood ◽  
Fungal Infections ◽  
Antifungal Prophylaxis ◽  
Hematopoietic Stem

Abstract Abstract 4547 Background Fungal infections remain a vital threat to the immunocompromised patient. Due to the high mortality rate of invasive mycoses, antifungal prophylaxis and prevention appear appropriate in some settings. Patients (pts) with prolonged and severe neutropenia or recipients of allogeneic hematopoietic stem cell transplantation (HSCT) appear to be at high risk for filamentous fungal infections, which are associated with low survival rates. However, there is no consensus on the optimal prophylaxis, eligible patients or its effectiveness and clinical impact. Objective To analyze the need for antifungal prophylaxis in Acute Leukemia patients receiving chemotherapy and the effectiveness of fluconazol, followed by posaconazol if GVHD developed, in recipients of allo-HSCT as antifungal prophylaxis. Methods and patients Period: from june’07 through june’09. Acute leukemia adult patients receiving chemotherapy as induction or re-induction therapy did not received primary antifungal prophylaxis. Recipientes of Allo-HSCT received 400 mg/d of fluconazole until discharge followed by 200 mg/8h of posaconazole if graft-versus-host disease (GVHD) developed, until its resolution. Patients received secondary antifungal prophylaxis according to their IFI. There were 77 pts who presented 218 episodes of post-chemotherapy neutropenia (80 in ALL and 138 in AML), 207 received no antifungal prophylaxis. On the other hand, we analyzed 40 consecutive Allo-HSCT adult recipients with an average age of 39 years (15-65) followed as in-patient and out-patient basis during a mean period of 18 months (3-24). Standard myeloablative or reduced intensity conditioning schemes were used and donors were HLA-identical sibling (27), unrelated donor (8) and umbilical cord blood (5). Diagnoses: AML (21), ALL (10), NHL (3), MDS (2), CML (2), HL (1) and AAS (1). The GVHD prophylaxis was according to standard protocols with MTX and CsP/MMF or standard umbilical cord blood protocols. Non-normal distribution data were expressed as median values (range). Chi-square test or Fisher exact test were used to compare differences between groups of categorical data. Differences were considered statistically significant for p-values < 0.05. All statistical analyses were performed using SPSS 16.0 software (Chicago, IL). Results Acute leukemia patients: There were 8 proved or probable fungal infections (EORTC/MSG consensus), with an incidence of 3.6%. The incidence of IFI in the whole induction AML group was 2.4%, (6.9% in the consolidation AML group, 25% in the re-induction AML group) and 5.2% in induction LLA and no case (0%) in the re-induction ALL group. As etiology, Aspergillus Fumigatus (1), Aspergillus spp (4), Candida tropicalis (1) and Candida spp (2). There were 3 deaths caused by IFI (37.5% of IFI); two of them in the re-induction AML group. Allogenic hematopoietic stem cell transplantation recipients: 33 patients received fluconazole (82.5%) and 4 pts (10%) fluconazole followed by posaconazole. Other 3 received posaconazole (2) or voriconazole 200 mg/12 hours (1) as secondary prophylaxis since the conditioning. There were 7 cases of IFI (incidence of 17.5%), 3 proved IFIs and 4 probable IFIs. As etiology, Aspergillus Fumigatus (2), Aspergillus spp (4) and Candida albicans (1). Six patients had received fluconazole and one (candidiasis), fluconazole and posaconazole. The mortality attributable to IFI were 4 cases (57% of IFI). There was no IFI in the group of 9 pts without GVHD and all IFIs occurred in patients treated for GVHD. Conclusions 1) Patients in re-induction of AML may require an effective prophylaxis against fungal infections, but not AML during induction or ALL in any situation. 2) The prophylaxis regimen studied in allogenic HSCT recipients was effective in preventing IFIs in patients without GVHD but not in patients with GVHD, particularly in the case of filamentous fungi. 3) The overall incidence of IFI in allo-HSCT was similar to that reported in other series of high risk and mortality from IFI similar to that described in recent years. 4) Patients with GVHD require more effective antifungal prophylaxis regimens and are candidates for clinical trials. Disclosures: No relevant conflicts of interest to declare.

Voriconazole prophylaxis in leukemic patients: A retrospective single-center study

2019 ◽  
Vol 26 (4) ◽  
pp. 873-881
Author(s):  
Vivian Bui ◽  
Sandra AN Walker ◽  
Marion Elligsen ◽  
Anju Vyas ◽  
Alex Kiss ◽  
...  
Keyword(s):  
Acute Leukemia ◽  
Fungal Infection ◽  
Invasive Fungal Infection ◽  
Fungal Infections ◽  
Lymphoblastic Leukemia ◽  
Retrospective Chart Review ◽  
Liver Function Tests ◽  
Antifungal Prophylaxis ◽  
Invasive Fungal Infections ◽  
Acute Myeloid

Background Invasive fungal infections commonly occur in acute myeloid and lymphoblastic leukemia patients receiving chemotherapy. In these patients with acute leukemia, posaconazole prophylaxis is recommended; however, voriconazole may be a less costly alternative. Objectives The objective of this study was to evaluate the efficacy and safety of voriconazole prophylaxis in acute leukemia patients. Methods A retrospective chart review of inpatients at Sunnybrook Health Sciences Centre between 2005 and 2017 was completed. Hospitalized adult acute leukemia patients who received voriconazole prophylaxis (cases) were compared to patients who received fluconazole or no prophylaxis during chemotherapy (controls). Statistical analyses comparing baseline characteristics, safety, and efficacy outcomes between the study cohorts were completed. A posaconazole literature-based weighted mean risk was compared to the voriconazole risk of invasive fungal infection identified in this study. Results Of 490 acute myeloid leukemia or acute lymphoblastic leukemia patients, 83 controls and 92 cases were eligible. Case patients received an average of 24.4 ± 10.8 days of voriconazole prophylaxis. The incidence of proven or probable invasive fungal infections with voriconazole was 3.3% (3/92) versus 7.2% (6/83) in the control cohort (p > 0.05) and was comparable to the literature reported weighted incidence of invasive fungal infection with posaconazole (2.4 ± 2.1%; 95% CI 1.3%–3.4%; p > 0.05). Voriconazole was well tolerated by patients (91%; 84/91; seven discontinued due to asymptomatic elevated liver function tests). Conclusions Voriconazole prophylaxis was found to be safe, effective, and comparable to literature-based efficacy data for risk of invasive fungal infection with posaconazole antifungal prophylaxis in patients with acute leukemia undergoing chemotherapy and could represent a significant cost advantage.

scholarly journals Total Ankle Arthroplasty

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
David Beck ◽  
Steven Raikin ◽  
David Pedowitz ◽  
Eric Padegimas
Keyword(s):  
Charlson Comorbidity Index ◽  
Elective Surgery ◽  
Demographic Variable ◽  
Inpatient Rehabilitation ◽  
The United States ◽  
Operative Outcomes ◽  
Significant Difference ◽  
Comorbidity Index ◽  
Academic Teaching Hospital ◽  
And Gender

Category: Ankle, Ankle Arthritis Introduction/Purpose: The number of total ankle arthroplasties (TAA) performed in the United States has risen significantly in recent years. Additionally, utilization of an orthopaedic specialty hospital (OSH) to treat healthy patients undergoing elective surgery is becoming more common. The effect of OSH utilization on post-operative outcomes following TAA has yet to be investigated. The purpose of this study is to compare post-operative outcomes following TAA at an OSH when compared to a matching population of patients undergoing TAA at an academic teaching hospital (ATH). Methods: We identified all primary, atraumatic TAA from January 2014 to December 2014 at the OSH and January 2010 to January 2016 at the ATH. Each OSH patient was manually matched to a corresponding ATH patient by clinical variables (age adjusted Charlson comorbidity index [AACCI], 17 individual comorbidity categories, and body mass index [BMI] and demographic variable (age, gender, and insurance type). Matching was performed in a blinded fashion to outcomes. Outcomes analyzed were LOS, 30-day readmissions, mortality, reoperation, and inpatient rehabilitation utilization. Results: There were 40 TAA patients in each group. OSH and ATH patients were similar in age (66.7 versus 66.8 yo, p=0.95), BMI (both 28.4, p=1.00), age-adjusted Charlson Comorbidity Index (both 3.3, p=1.00), and gender (both 45.0% male, p=1.00). Average LOS for TAA at the OSH was 1.28+/-0.51 compared to 2.03+/-0.89 (p<0.001) at the ATH. No OSH patients were readmitted within 30 days, compared to 2 ATH (5.0%; p=0.15). Two OSH patients (5.0%) and two ATH patients (5.0%; p=1.00) required reoperation. There were no mortalities in either group. No OSH patients utilized inpatient rehabilitation compared to 3 ATH patients (7.5%; p=0.078). When excluding patients utilizing inpatient rehabilitation, patients at the OSH still demonstrated significantly lower LOS (1.28+/-0.51 vs 1.81+/-0.69 days; p<0.001). No OSH patients required transfer. Conclusion: Primary TAA performed at an OSH had significantly shorter LOS when compared to a matched patient treated at an ATH with no significant difference in readmission or reoperation rates. Additionally, patients who had their procedure performed at an OSH utilized inpatient rehabilitation less frequently than those at an ATH. This study suggests that performing TAA at an OSH offers a potential source of significant healthcare savings.

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