Analysis of factors related to the occurrence of chronic disseminated candidiasis in patients with acute leukemia in a non-bone marrow transplant setting - A follow-up study

BACKGROUND. Chronic disseminated candidiasis (CDC) is a serious complicatio n of treatment in patients with acute leukemia. Although some general risk factors are known to predispose to systemic fungal infections, few studies have addressed the relevance of certain clinical and laboratory features in patients with CDC., PATIENTS AND METHODS. To define a subset of patients at high risk for CDC, the authors evaluated the demographics and clinical and laboratory characte ristics of 423 patients with acute leukemia. Patients who had bone marrow t ransplant before the diagnosis of CDC were excluded from the analysis. The diagnosis of CDC was based on blood cultures, liver biopsy, and imaging stu dies. The authors conducted 2 separate regression analyses on 3 subsets of patients: patients without documented candidiasis (n = 374), patients with CDC (n = 23), and patients with candidemia (n = 26). RESULTS. According to multivariate analysis, younger age (P = 0.009; odds r atio [OR], 1.96; 95% confidence interval [CI], 1.72-2.99), duration of neut ropenia of 15 days or longer (P = 0.0003; OR, 11.7; 95% CI, 3.04-45.1), and use of prophylactic quinolone antibiotics (P = 0.039; OR, 3.85; 95% CI, 1. 11-13.4) emerged as independent factors related to the development of CDC i n patients with acute leukemia. The presence of severe mucositis, colonizat ion with Candida, and administration of high-dose ara-C were statistically significant parameters in univariate analysis only (P = 0.0001, P = 0.003, and P = 0.058, respectively). CONCLUSIONS. On the basis of the results of this investigation, it is possi ble to define a subset of patients with acute leukemia at very high risk fo r CDC. Because of the morbidity and mortality of this infection, a targeted prophylactic approach may be more effective and less costly than the rando m administration of antifungal agents. (C) 2001 American Cancer Society.