A Retrospective Study Of Invasive Fungal Disease In Patients Diagnosed With Acute Lymphoblastic Leukemia During First Induction Chemotherapy

Objective:To identify the incidence of invasive fungal disease (IFD) in patients diagnosed with acute lymphoblastic leukemia (ALL) during first induction chemotherapy, analyze the clinical features of those patients and reveal the risk factors and prognosis.Methods:208patients with ALL who were initially diagnosed in the First Affiliated Hospital of Zhejiang University from January2010to October2013were enrolled. According to the diagnosis of IFD,208patients were divided into two groups, with-IFD and without-IFD group. We retrospectively analyzed the clinical characteristics between these two groups. Besides, Follow-up study was preceded via phone to obtain data for survival status.Results:Among the208cases studied, IFD incidence rate was14.4%, including4probable IFD(1.9%) and26possible IFD(12.5%). Multivariate logistic regression analysis indicated that Philadelphia chromosome positive (Ph+)(OR3.835,95%confidence interval:1.385-10.618), WBC>10*109/L(OR3.540,95%CI:1.062-11.795) and durations of neutropenia>10days(OR5.752,95%CI:1.837-18.014) were the possible risk factors for developing IFD in ALL patients during first induction chemotherapy while the empirical treatment(OR0.170,95%CI:0.050-0.577) could reduce the incidence rate of IFD. Kaplan-Meier survival analysis found no significant difference between two groups in overall survival (p=0.52) and refractory free survival (p=0.46).Conclusion:This study shows that the incidence rate of IFD in ALL patients during first induction chemotherapy is14.4%. Ph+, WBC>10*109/L、durations of neutropenia>10days are the possible risk factors for developing IFD in those patients. For high risk patients, antifungal prophylaxis is recommended, and early empirical antifungal therapy could reduce the incidence rate of IFD. For those who have been diagnosed with IFD, timely and proper treatment to avoid IFD related mortality could achieve same survival as those without IFD.