Invasive Mould Disease – Predictive Risk Factors in Acute Leukemia Patients Receiving Intensive Chemotherapy and its Impact on Survival

Background: Invasive mould disease (IMD) after chemotherapy in patients with acute leukemia has traditionally caused much morbidity and mortality. Methods: We conducted a retrospective, matched case-control study of IMD in patients with acute leukemia managed in our institution from January 2004 to March 2007 to determine the incidence and clinical outcomes of IMD, including its impact on 1-year survival. Results: During this period, 172 patients with acute leukemia underwent chemotherapy with curative intent. A probable or proven IMD developed in 19 patients (cases), giving an incidence of 11%. Aspergillus was the commonest mould. Cases were more likely than controls to have prolonged neutropenia, fever that did not respond to carbapenems, a bacteremia and a longer length of stay. Three-month survival was 93.3% among both cases and controls, but one-year survival was 46.7% among cases and 93.3% among controls. Having an IMD appears to impart a higher risk of mortality at one year. Conclusion: The incidence of invasive mould disease in acute leukemia patients receiving chemotherapy is 11%. Absolute neutropenia more than 14 days is a risk factor for IMD. Itraconazole prophylaxis did not reduce the likelihood of an IMD and a change should be considered. Having an IMD appeared to predict mortality at 12 months.