Expert Perspectives: Management of Acute Myeloid Leukemia - Episode 6

The Challenge of Fungal Infections in AML

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In this segment, Kieren A. Marr, MD, professor of medicine in the Johns Hopkins School of Medicine, professor of oncology in the Sidney Kimmel Comprehensive Cancer Center, and medical director of the Transplant and Oncology Infectious Diseases program at Hopkins, emphasizes the importance of prevention of fungal infections, as they provide many challenges in managing and treating acute myeloid leukemia (AML).

The prevalence of breakthrough fungal infections is high in individuals who are not receiving any therapy to prevent it, especially in those with prolonged neutropenia and breakdown of the gastrointestinal (GI) tract. The infections can occur as a result of the overgrowth of organisms already present in the GI tract, such as candida, according to Kieren A. Marr, MD. For example, chronic candidiasis can develop when those invasive organisms escape into the bloodstream or the portal vascular. In addition, patients who have suppressed secondary responses because of persistent neutropenia are at risk for invasive pulmonary fungal infections, such as aspergillosis.

One of the problems with determining an accurate prevalence of these fungal infections is the lack of diagnostics, especially in infections involving the lungs, states Marr. Establishing the diagnosis is challenging because the organisms do not grow rapidly from the blood or lungs. However, diagnosing fungal infections has improved over the past 10 years.

The underlying morbidity associated with treating AML also adds to the complexity of diagnosing invasive fungal infections. For example, gut mucositis that can occur with AML can lead to false-positive tests on the antigen-based assays.