# Invasive Fusariosis Among Patients with Acute Leukemia: A 12-Year Single-Center Experience in a Middle-Income Country

## TL;DR

This study examines the outcomes of patients with acute leukemia and invasive fusariosis in a middle-income country, highlighting high mortality and the impact of antifungal prophylaxis.

## Contribution

The paper provides a 12-year single-center analysis of invasive fusariosis in acute leukemia patients from a middle-income country.

## Key findings

- Invasive fusariosis was associated with extensive dissemination and high 30-day mortality (38.5%).
- Patients undergoing re-induction therapy had significantly higher mortality.
- Antifungal prophylaxis was linked to lower mortality rates.

## Abstract

Invasive fusariosis (IF) is one of the most aggressive mold infections in patients with acute leukemia, characterized by rapid dissemination, high rates of fungemia, and limited antifungal susceptibility. Its impact is particularly severe in middle-income countries, yet single-center data from these settings remain scarce.

We conducted a retrospective study of all patients with acute leukemia and proven IF, diagnosed according to EORTC/MSG criteria, from January 2011 to August 2023. Demographic, clinical, therapeutic, and outcome variables were analyzed.

Twenty-six patients were identified. Median age was 46.5 years, and 53.8% were female. Acute myeloid leukemia was the most frequent underlying condition. All patients presented with severe neutropenia at diagnosis. Disseminated disease occurred in 84.6% of cases; two patients had isolated fungemia and two had localized skin disease. Cutaneous lesions were present in 73% of patients, and 31% had pulmonary involvement. Antifungal prophylaxis, mainly fluconazole or anidulafungin, was used in 69.2% of cases. Treatment consisted of lipid formulations of amphotericin B, either alone or combined with voriconazole. Thirty-day mortality reached 38.5%. Mortality was significantly higher among patients undergoing re-induction therapy, whereas those who had received antifungal prophylaxis exhibited lower mortality.

IF in acute leukemia was associated with extensive dissemination and substantial early mortality. Mortality rates were higher in patients in re-induction therapy and lower in those who received antifungal prophylaxis. The role of combination antifungal therapy requires further investigation.