Characterisation of infections in patients with acute myeloid leukaemia receiving venetoclax and a hypomethylating agent

Sandy On; Carolyn G Rath; Michelle Lan; Bobby Wu; Kimberly M Lau; Edna Cheung; William Alegria; Rebecca Young; Marisela Tan; Carrie Kim; Jennifer Phun; Nimish Patel; Gabriel Mannis; Aaron C Logan; Vanessa Kennedy; Aaron Goodman; Randy A Taplitz; Patricia A Young; Raymond Wen; Ila M Saunders

doi:10.1111/bjh.18051

Characterisation of infections in patients with acute myeloid leukaemia receiving venetoclax and a hypomethylating agent

Br J Haematol. 2022 Apr;197(1):63-70. doi: 10.1111/bjh.18051. Epub 2022 Feb 16.

Authors

Sandy On¹, Carolyn G Rath², Michelle Lan³, Bobby Wu⁴, Kimberly M Lau¹, Edna Cheung¹, William Alegria⁵, Rebecca Young², Marisela Tan², Carrie Kim⁴, Jennifer Phun⁴, Nimish Patel⁶, Gabriel Mannis⁷, Aaron C Logan⁸, Vanessa Kennedy⁸, Aaron Goodman⁹, Randy A Taplitz¹⁰, Patricia A Young¹¹, Raymond Wen⁶, Ila M Saunders⁶

Affiliations

¹ Department of Pharmacy, Stanford Health Care, Stanford, CA, USA.
² Department of Pharmaceutical Services, University of California, San Francisco Health, San Francisco, CA, USA.
³ Department of Pharmacy, University of California, San Diego Health, San Francisco, CA, USA.
⁴ Department of Pharmacy, University of California, Los Angeles Health, Los Angeles, CA, USA.
⁵ Department of Quality, Patient Safety and Effectiveness, Stanford Health Care, Stanford, CA, USA.
⁶ Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, USA.
⁷ Division of Hematology, Stanford Cancer Institute, Stanford University, Stanford, CA, USA.
⁸ Division of Hematology and Oncology, University of California, San Francisco Health, San Francisco, CA, USA.
⁹ Division of Blood & Marrow Transplant, Department of Medicine, University of California, San Diego Health, La Jolla, CA, USA.
¹⁰ Department of Medicine, City of Hope Medical Center, Duarte, CA, USA.
¹¹ Division of Hematology/Oncology, University of California Los Angeles Medical Center, Los Angeles, CA, USA.

PMID: 35174480
DOI: 10.1111/bjh.18051

Abstract

We investigated the incidence of invasive fungal infections (IFIs) and other infectious complications in patients receiving venetoclax and hypomethylating agent therapy for acute myeloid leukaemia (AML). This retrospective, multicentre cohort study included adult patients with AML who received at least one cycle of venetoclax and either azacitidine or decitabine between January 2016 and August 2020. The primary outcome was the incidence of probable or confirmed IFI. Secondary outcomes included antifungal prophylaxis prescribing patterns, incidence of bacterial infections, and incidence of neutropenic fever hospital admissions. Among 235 patients, the incidence of probable or confirmed IFI was 5.1%. IFI incidence did not differ significantly according to age, antifungal prophylaxis use, or disease status. In the subgroup of patients with probable or confirmed IFIs, six (50%) were receiving antifungal prophylaxis at the time of infection. The overall incidence of developing at least one bacterial infection was 33.6% and 127 (54%) patients had at least one hospital admission for febrile neutropenia. This study demonstrated an overall low risk of developing probable or confirmed IFI as well as a notable percentage of documented bacterial infections and hospital admissions due to neutropenic fever.

Keywords: acute myeloid leukaemia; fungal infections; hypomethylating agent; infectious complications; venetoclax.

MeSH terms

Adult
Antifungal Agents / therapeutic use
Bridged Bicyclo Compounds, Heterocyclic
Cohort Studies
Humans
Invasive Fungal Infections* / epidemiology
Leukemia, Myeloid, Acute* / complications
Retrospective Studies
Sulfonamides

Substances

Antifungal Agents
Bridged Bicyclo Compounds, Heterocyclic
Sulfonamides
venetoclax