Invasive fungal infections (IFIs) remain one of the worrying complications in patients with acute myeloid leukemia (AML) due to their incidence and high level of attributable mortality. In light of ...these risks, antifungal prophylaxis has always been debated. We conducted a single-center retrospective study of two prophylactic antifungal agents (fluconazole/posaconazole) in 91 consecutive patients receiving induction chemotherapy for AML between 2005 and 2009, in order to evaluate the impact on the incidence of IFI and on the mycological flora of the patients.
In total, 39 patients received prophylactic fluconazole versus 52 who received posaconazole. The baseline characteristics of the two groups were comparable.
Overall, 17 patients developed an IFI, with no difference in frequency between the two groups. Utilization of empirical or pre-emptive therapy was similar irrespective of the type of prophylaxis used. Mycological examination of stools revealed an increase in non-albicans Candida colonization in the fluconazole group during hospitalization and the appearance of Saccharomyces cerevisiae colonization in patients receiving posaconazole.
The present study does not distinguish between fluconazole and posaconazole as a primary effective prevention against fungal infections. More prospective studies and meta-analyses are warranted.
Little data have been published concerning invasive fungal infections during treatment of acute lymphoblastic leukemia (ALL). Patients included between May 2006 and October 2012 in the multicenter ...phase III trial for newly diagnosed ALL (GRAALL-2005) were retrospectively reviewed for the occurrence of IFI using the EORTC modified criteria. These patients did not routinely receive antifungal prophylaxis. Among 969 patients included (median age 47 years), 65 (6.7%) developed IFI during induction chemotherapy: 26 (3.3%) invasive aspergillosis (IA), 33 (3.4%) invasive candidiasis (IC) and six other IFI. For IA, the median time between induction therapy and IA diagnosis was 20 days. Diagnosis was probable in 22 cases and proven in four. Aspergillus antigen in serum was tested in all cases and positive in 24. Overall 12-week mortality after diagnosis of IA was 5/26 and attributable mortality related to the infection was 4/26 (15.4%). For IC, the median time between induction therapy and diagnosis was 19 days. Diagnosis was proven in 29 episodes. Candida albicans was the major pathogen in yeast infections (16/27). Overall 12-week mortality after diagnosis of IC was 8/33 (24.2%) and attributable mortality related to the infection was 7/33. The median delay between induction chemotherapy initiation and attributable death related to IC was 15 days. These findings may help to optimize the future management of ALL patients, and as in AML advocate systematic monitoring and the development of prophylactic or preemptive antifungal treatments.
BACKGROUND
Patients with hematologic malignancies are at high risk for both thrombosis and bleeding. During the prolonged periods of thrombocytopenia experienced by patients who are receiving ...intensive chemotherapy, clinicians often hesitate to prescribe any protection against thrombosis. In case of anticoagulant prescription, it is the prescribers' responsibility to weigh risks and benefits for each patient. Current guidelines exist but do not take into account types of thrombosis, patients' comorbidities, or previous bleeding events.
STUDY DESIGN AND METHODS
We proposed to gain insight into hematologists' beliefs about antithrombotic prescription in hematologic malignancy patients, to design future clinical trials. Therefore, we conducted a survey in France to evaluate the practices among a panel of hematologists.
RESULTS
We found that more than 92% of the respondents prescribed therapeutic anticoagulation in case of pulmonary embolism or deep venous thrombosis. In the case of therapeutic anticoagulation, only 64% of the physicians reconsidered treatment under a platelet threshold of 50 × 109/L. None of the respondents decided to renounce treatment, nor to discontinue it because of thrombocytopenia, except in distal venous thrombosis or superficial vein thrombosis. One‐fifth of clinicians proposed the insertion of a vena cava filter.
CONCLUSION
As observed in the United States and Canada, we noticed discrepancies between recommendations and current practices in France. This highlights the urgent need to conduct studies to evaluate both efficacy and safety of antithrombotics in patients with hematologic cancer and thrombocytopenia.
Azacytidine and venetoclax combination regimen (AZA/VEN) is the standard of care in AML settings for unfit to intensive chemotherapy patients. However, AZA/VEN is associated with an increased ...hematological toxicity compared to AZA alone. In this context, alternative AZA/VEN regimens emerged progressively based on each physician experience and local procedures. Moreover, AZA/VEN is now recognized as a valuable therapeutic option in R/R settings, even if no prospective trials addressed this question. In this multicenter study, we aimed to evaluate the efficacy and safety of various AZA/VEN regimen in frontline and R/R patients diagnosed with AML. We retrospectively analyzed 108 patients from 6 different French centers in Auvergne Rhône Alpes (AURA) region, between January 2019 and December 2022. The entire cohort was composed of 64 and 44 patients in frontline and R/R settings. Regarding European LeukemiaNet 2017 risk groups, 12%, 31.5% and 53.7% were favorable, intermediate and unfavorable, respectively. In frontline settings, composite complete remission (CRc) rate was 55.5% and median overall survival (OS) was 11.9 months. Venetoclax dosage (400 mg vs 100 mg/d) and duration per cycle (28 days vs others) did not seem to influence significantly CRc rate probability. Febrile neutropenia (FN) occurred in 59.3%, 23.3% and 18.3% in Cycles 1, 2 and 3, respectively. In or outpatient management for Cycle 1 did not influence FN incidence. During Cycle 1, shorter venetoclax duration regimens (<21 days/cycle) was associated with lower FN (40% vs 66%, P=0.03) compared to ≥21-day VEN cycle. Regarding impact of azole on invasive fungal infection frequency, there was no difference between azole-exposed and non-exposed patients. In R/R settings, CRc rate was 43.8% and OS was 7.9 months. As in frontline settings, VEN dosage and duration per cycle did not influence CR rate probability. In this real-life-settings study, our results suggested that alternative AZA/VEN regimens were not associated with lower response rate and OS. Reducing VEN exposure during Cycle 1 may reduce FN incidence without significant consequences on CR rate probability. An update with 110 additional patients will be presented at the meeting.
Summary
This 16‐month‐long multicentre retrospective study of 225 allogeneic haematopoietic stem cell transplantation (alloHSCT) recipients with COVID‐19 examines risk factors for severity and ...mortality, describing the successive waves of infections (from March to June 2020 and from August 2020 to June 2021). We confirm the negative role of low respiratory tract disease and immunosuppressive treatment. We highlight significantly lower percentages of severe forms and COVID‐19‐related mortality during the second wave. Monthly comparative evolution of cases in alloHSCT recipients and in the French population shows a higher number of cases in alloHSCT recipients during the first wave and a decrease from February 2021.
Promyelocytic sarcoma is an uncommon solid tumor made up of myeloblasts. It is characterized, like acute promyelocytic leukemia (APL), by a chromosomal translocation t(15;17) involving the retinoic ...acid receptor alpha (RARalpha) and the promyelocytic gene (PML). The diagnosis and monitoring of promyelocytic sarcoma is a challenge due to the rarity and severity of the disease.
We describe a case with several initial sites and without APL. The patient was monitored with regular 18F-FDG PET/CT from diagnosis to complete response. The evolution of PET/CT imageries was compared to the quantification of PML-RARα fusion gene by RQ-PCR. In promyelocytic sarcoma medical care, 18F-FDG PET/CT appears to be an attractive tool for finding targets for biopsy, for the primary staging, for assessing therapeutic response and for detecting early relapse.
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