Invasive aspergillosis as a cause of death was evaluated in older patients with acute myeloid leukemia (AML) or high-risk myelodysplastic syndrome (MDS) who participated in the Haemato-Oncology Foundation for Adults in the Netherlands (HOVON)-43 trial. Results were reported in the journal BMC Infectious Diseases.
HOVON-43 was a randomized, controlled trial conducted from 2000 through 2006. The study included patients with AML or high-risk MDS and examined daunorubicin dosing for use in patients over 60 years of age with either condition. Antifungal prophylaxis was not used in this study.
Older patients could have immunosenescence leading to susceptibility to infection, or other vulnerabilities. The researchers who performed this analysis aimed to investigate the cumulative incidence of death related to different causes, and the impact of invasive aspergillosis on causes of death, in patients of this trial. The research team evaluated patient clinical data and the cumulative incidence of death from varied causes at multiple time points after diagnosis.
The analysis included 806 patients, with a mean age of 70 years (range, 61-88 years) at diagnosis, 88.1% of whom died within the study period. Invasive aspergillosis occurred with an incidence of 21.2%, affecting 171 patients. Recovery occurred in 40 of these patients, whereas 131 patients experienced it into the final cycle of chemotherapy, and 121 of these patients died. Leukemia was considered the most likely cause of death overall in this study, but during the first year following AML or high-risk MDS diagnosis, the most likely cause of death tended to be infection or other causes.
Invasive aspergillosis was linked to an increased risk of death from leukemia, with a cause-specific hazard ratio of 1.750 (95% CI, 1.341-2.282), when invasive aspergillosis was diagnosed in the final cycle of treatment. Invasive aspergillosis showed a nonsignificant trend toward increased risk of death from infection and other causes, with a cause-specific hazard ratio of 1.359 (95% CI, 0.958-1.909).
The researchers concluded that while overall leukemia was the main cause of death in this population, during the first year following AML or high-risk MDS diagnosis, infection was the main cause of death in the study population. Invasive aspergillosis appeared to contribute to death related to leukemia or infection. The researchers considered the high rate of invasive aspergillosis in this population to support the use of antifungal prophylaxis in certain patients.
van Grootveld R, Masarotto V, von dem Borne PA, et al. Effect of invasive aspergillosis on risk for different causes of death in older patients with acute myeloid leukaemia or high‑risk myelodysplastic syndrome. BMC Infect Dis. 2023;23(1):78. doi:10.1186/s12879-023-08013-5