Invasive Fungal Infections in Acute Promyelocytic Leukemia on Dual Differentiating Agents: Real World Data

  • Uday Yanamandra
  • Parathan Karunakaran
  • Alka Khadwal
  • Gaurav Prakash
  • Deepesh Lad
  • Shano Naseem
  • Neelam Varma
  • Arunaloke Chakrabarti
  • Subhash Varma
  • Pankaj Malhotra
Short Communication
  • 15 Downloads

Abstract

Invasive fungal infection (IFI) in patients with acute promyelocytic leukemia (APL) is a common phenomenon in developing countries. In a systematic study (Dual Inducing Differentiating agents—Indian Trial: DID-IT) using dual differentiating agents (ATO and ATRA) in 98 APL patients at our center we report 18.3% incidence of IFI (n-18). Among all cases of IFI three were definitive, 14 were probable and one was possible IFI. We conclude that incidence of IFI in APL is affected by environmental and therapy related factors and mere usage of dual differentiating agents need not necessarily decrease the incidence of fungal infections.

Keywords

APL Fungal infection ATO ATRA 

Notes

Authors’ Contributions

All authors participated in the study, YU, PKK and PM analyzed the data and wrote the paper, SV and PM designed the research study and AC’s laboratory performed fungal studies. All authors were involved in the management of the patients. YU and PM were involved in the manuscript preparation. All authors vetted the submitted manuscript.

Funding

This study was not funded by any agency.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Malhotra P, Varma N, Arora N, Das R, Nath A, Patel FD et al (2010) Treatment of therapy related acute promyelocytic leukemia with the combination of all trans retinoic acid and arsenic trioxide without chemotherapy: a series of three patients. Leuk Lymphoma 51(5):933–936CrossRefPubMedGoogle Scholar
  2. 2.
    Varma S, Yanamandra U, Khadwal A, Prakash G, Suri V, Kumari S et al (2015) High risk Apml treated successfully with four cycles of ATO and ATRA combination in resource constrained settings. Blood 126(23):3322Google Scholar
  3. 3.
    Kakkar N, Bharani V, Gupta O, Shrestha D, Das A, Varma SC (2015) Respiratory distress in acute promyelocytic leukemia after ATRA therapy: not always due to differentiation syndrome. Clinicopathological conference report—PM25443. J Postgrad Med Edu Res 49(2):94–100. doi: 10.5005/jp-journals-10028-1155 CrossRefGoogle Scholar
  4. 4.
    De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T et al (2008) Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 46(12):1813–1821CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Jain A, Prakash G, Singh C et al (2017) Analysis of clinical profile and outcome of tuberculosis in patients with acute leukemia. Indian J Hematol Blood Transfus. doi: 10.1007/s12288-017-0875-z
  6. 6.
    Ghavamzadeh A, Alimoghaddam K, Rostami S, Ghaffari SH, Jahani M, Iravani M et al (2011) Phase II study of single-agent arsenic trioxide for the front-line therapy of acute promyelocytic leukemia. J Clin Oncol 29(20):2753–2757CrossRefPubMedGoogle Scholar
  7. 7.
    Tallman MS, Andersen JW, Schiffer CA, Appelbaum FR, Feusner JH, Ogden A et al (2000) Clinical description of 44 patients with acute promyelocytic leukemia who developed the retinoic acid syndrome. Blood 95(1):90–95PubMedGoogle Scholar
  8. 8.
    Pagano L, Stamouli M, Tumbarello M, Verga L, Candoni A, Cattaneo C et al (2015) Risk of invasive fungal infection in patients affected by acute promyelocytic leukaemia. A report by the SEIFEM-D registry. Br J Haematol 170(3):434–439CrossRefPubMedGoogle Scholar
  9. 9.
    Sharma SK, Kumar S, Singh AK, Seth T, Mishra P, Mahapatra M et al (2013) Feasibility and outcome of CT-guided lung biopsy in patients with hematological diseases and suspected fungal pneumonia. J Infect Dev Ctries 7(10):748–752CrossRefPubMedGoogle Scholar

Copyright information

© Indian Society of Hematology and Blood Transfusion 2017

Authors and Affiliations

  • Uday Yanamandra
    • 1
  • Parathan Karunakaran
    • 2
  • Alka Khadwal
    • 2
  • Gaurav Prakash
    • 2
  • Deepesh Lad
    • 2
  • Shano Naseem
    • 3
  • Neelam Varma
    • 3
  • Arunaloke Chakrabarti
    • 4
  • Subhash Varma
    • 2
  • Pankaj Malhotra
    • 2
  1. 1.Department of Haematology and Stem Cell TransplantArmy Hospital (Research and Referral)DelhiIndia
  2. 2.Department of Internal Medicine and Clinical HematologyP.G.I.M.E.RChandigarhIndia
  3. 3.Department of HematopathologyP.G.I.M.E.RChandigarhIndia
  4. 4.Department of Medical MicrobiologyP.G.I.M.E.RChandigarhIndia

Personalised recommendations