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ORIGINAL RESEARCH article

Front. Oncol.
Sec. Hematologic Malignancies
Volume 14 - 2024 | doi: 10.3389/fonc.2024.1429221

Effectiveness of high efficiency particulate (HEPA) air condition combined with the antifungal prophylaxis on incidence, morbidity and mortality of invasive fungal infections (IFI) in patients with acute myeloid leukemia: a retrospective single-center study

Provisionally accepted
Linda Preyer Linda Preyer 1Eik Vettorazzi Eik Vettorazzi 2Walter Fiedler Walter Fiedler 3Holger Rohde Holger Rohde 4Jannik Stemler Jannik Stemler 5Saskia Gönner Saskia Gönner 6Carsten Bokemeyer Carsten Bokemeyer 6Cyrus Khandanpour Cyrus Khandanpour 7Friederike Wortmann Friederike Wortmann 7Maxim Kebenko Maxim Kebenko 7*
  • 1 Clinic for Orthopedics, Accident and Spine Surgery, Sana-Hospital Remscheid., Remscheid, Germany
  • 2 Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
  • 3 Department of Oncology, Hematology and Bone Marrow Transplantation with Section of Pneumology, Center for Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
  • 4 Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
  • 5 University of Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany, Cologne, Germany
  • 6 Center for Oncology, University Medical Center Hamburg Eppendorf, Hamburg, Hamburg, Germany
  • 7 Department of Hematology and Oncology, University Medical Center Schleswig-Holstein, Lübeck, Germany

The final, formatted version of the article will be published soon.

    Our monocentric and retrospective study aimed to investigate the clinical effectivity of HEPA filters in combination with the antifungal drug prophylaxis in patients with AML undergoing intensive chemotherapy and allogeneic stem cell transplantation (SCT).We included 177 patients between 2005 and 2015 representing a total of 372 in-hospital stays, 179 in the HEPA cohort (+HEPA) and 193 in the cohort without HEPA filters (-HEPA). No significant additional benefit of HEPA filtration on the risk reduction of IFI was observed. HEPA filtration did not significantly affect the risk of intensive care unit (ICU) admissions or early mortality rates. In patients who received allogeneic SCT in first complete remission with antifungal drug prophylaxis during prior induction treatment, a numerical but not significant improvement in long-term overall survival was noted in the +HEPA cohort compared to the -HEPA cohort (55% to 66%, p = 0.396). For better depicting of the clinical reality, we determined the so-called clinical suspected IFI (csIFI) -defined as cases with antifungal treatment after recommended prophylaxis without fulfilling current EORTC criteria. Especially in patients with a high risk for second IFI, significant risk reduction of csIFI and frequency of ICU admissions was observed when voriconazole was used as secondary antifungal prophylaxis. (csIFI, adjusted effect: OR 0.41, 95% CI (0.21 -0.82), p = 0.01; csIFI, subgroup-specific effect: OR 0.35, 95% CI (0.15 -0.78), p = 0.01; ICU, adjusted effect: OR 0.44, 95 CI (0.19 -1.01), p = 0.05; respectively).In summary, the study suggests the efficacy of secondary antifungal prophylaxis in preventing IFI in AML patients undergoing intensive treatment. The addition of HEPA filtration also demonstrated additional numerous benefits in reducing the frequency of IFIassociated complications.

    Keywords: HEPA, IFI/EORTC, Posaconazole, Voriconazole, primary, secondary antifungal drug prophylaxis

    Received: 07 May 2024; Accepted: 09 Sep 2024.

    Copyright: © 2024 Preyer, Vettorazzi, Fiedler, Rohde, Stemler, Gönner, Bokemeyer, Khandanpour, Wortmann and Kebenko. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Maxim Kebenko, Department of Hematology and Oncology, University Medical Center Schleswig-Holstein, Lübeck, Germany

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