Broad-spectrum antifungal prophylaxis is currently considered the standard of care for adults with de novo AML for the prevention of invasive fungal infections (IFIs), especially invasive pulmonary aspergillosis (IPA). Because fluconazole has been used in our center as anti-yeast prophylaxis, we sought to analyze in detail the incidence of IFIs over a 17-year period, as well as their impact on outcome. A standardized protocol of patient management, including serum galactomannan screening and thoracic CT-guided diagnostic-driven antifungal therapy, was used in all patients. A total of 214 consecutive adults with de novo AML who were treated in 3 CETLAM (Grupo Cooperativo para el Estudio y Tratamiento de las Leucemias Agudas y Mielodisplasias) protocols from 2002 to 2018 were included. The 90-day incidence of any IFI (including possible cases) was 11% (95% CI 4–15%), most cases occurred during induction chemotherapy (8%, 95% CI 4–12%), and most cases were probable/proven IPA (8%, 95% CI 3–13%). Developing an IFI during induction and consolidation had no impact on 1-year survival. A case–control study with 23 cases of IPA and 69 controls identified induction/re-induction chemotherapy, chronic pulmonary disease and age > 60 years/poor baseline performance status as potential pretreatment risk factors. The current study proves that inpatient induction and consolidation chemotherapy for de novo AML can be given in areas with “a priori” high-burden of airborne molds with fluconazole prophylaxis, while the selective use of anti-mold prophylaxis in patients at very high risk may further reduce the incidence of IFI in this specific clinical scenario.

广谱抗真菌预防目前被认为是成人 AML 成人预防侵袭性真菌感染 (IFI)，尤其是侵袭性肺曲霉病 (IPA) 的标准护理。由于我们中心已将氟康唑用作抗酵母菌预防剂，因此我们试图详细分析 17 年间 IFI 的发生率及其对结果的影响。所有患者均采用标准化的患者管理方案，包括血清半乳甘露聚糖筛查和胸部 CT 引导的诊断驱动的抗真菌治疗。共纳入了 214 名从 2002 年至 2018 年在 3 个 CETLAM（Grupo Cooperativo para el Estudio y Tratamiento de las Leucemias Agudas y Mielodisplasias）方案中治疗的新发 AML 成人患者。任何 IFI（包括可能的病例）的 90 天发生率为 11%（95% CI 4-15%），大多数病例发生在诱导化疗期间（8%，95% CI 4-12%），大多数病例很可能/ 经证实的 IPA（8%，95% CI 3–13%）。在诱导和巩固期间发展 IFI 对 1 年生存率没有影响。一项包含 23 例 IPA 和 69 名对照的病例对照研究将诱导/再诱导化疗、慢性肺病和年龄 > 60 岁/基线体能状况不佳列为潜在的治疗前风险因素。目前的研究证明，对于新发 AML 的住院诱导和巩固化疗可以在“先验”高负担空气传播霉菌的地区给予氟康唑预防，