Primary fungal prophylaxis in acute leukemia patients with different risk factors: retrospective analysis from the CAESAR study.

Invasive fungal disease (IFD) is a major cause of morbidity and mortality in acute leukemia (AL) patients. The impact of primary antifungal prophylaxis (PAP) on AL patients with different risk factors is unclear. We analyzed 2015 Chinese AL patients who received a total of 2274 chemotherapy courses, including 1410 courses in acute myeloid leukemia (AML) patients and 864 courses in acute lymphocytic leukemia (ALL) patients. The IFD incidence was significantly higher among AML than ALL patients (11.8 vs. 7.1%, P < 0.001) and in patients receiving induction chemotherapy than in those receiving consolidation chemotherapy (21.6 vs. 3.7%, P < 0.001). Induction chemotherapy, decreased serum albumin, indwelling central venous catheters, parenteral nutrition, and male gender were independent risk factors for IFD in AL patients, whereas PAP independently protected against IFD development. For patients on induction chemotherapy, PAP significantly reduced IFD incidence (P < 0.001). For patients on consolidation chemotherapy, however, PAP did not significantly alter IFD incidence, although PAP did lower IFD incidence in patients with certain risk factors. PAP is highly recommended for patients on induction therapy; for those on consolidation chemotherapy, PAP should be considered for patients who present with severe neutropenia, decreased albumin, and/or an indwelling central venous catheter.