Association of reduced total iron binding capacity and fungal infections in leukemic granulocytopenic patients.
Abstract
Serum total iron-binding capacity (TIBC) was measured serially on 70 patients with acute leukemia throughout the period of chemotherapy-induced granulocytopenia. Fungal infections were documented in 13 of these patients (18.6%), while 41 patients (58.6%) had clinically suspected fungal infections and 16 (22.9%) had no evidence of fungal infections during the granulocytopenia. Documented fungal infection occurred in patients with the greatest reduction in TIBC (P less than .015). Early reduction in TIBC also correlated with a greater risk for occurrence of fungal infection, and the earliest institution of amphotericin B (Amp-B) (P less than .004). Effective antifungal therapy was further associated with a return of TIBC levels toward normal. These data demonstrate that altered iron metabolism during granulocytopenia is associated with the development of fungal infections in compromised patients. Serial monitoring of TIBC, along with other clinical and mycologic findings, may prove useful in developing strategies for predicting patients at risk for developing a fungal infection and directing the appropriate use of empiric therapy with Amp-B.
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Individuals with malignant hematological disorders, such as acute myeloid leukemia, sustain increased mycoses, especially by Candida and Aspergilli.
“Individuals with malignant hematological disorders, such as acute myeloid leukemia, who typically present with very high serum Fe, serum ferritin and transferrin saturation, are known to sustain increased mycoses, especially by Candida and Aspergilli [38], [39].”
From Host Iron Withholding Demands Siderophore Utilization for Candida glabrata to Survive Macrophage Killing (2011) · cites this paper as [39]
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- Authors
- Karp, J. E., & Merz, W. G.
- ORCID
- Karp, J E
- Venue
- Journal of Clinical Oncology
- Published
- 1986-02
- Volume
- 4
- Issue
- 2
- Pages
- 216-220
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W2170263520
- Cited by
- 35
- References
- 24
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 1 · 2022: 2 · 2021: 2 · 2017: 1 · 2013: 2 · 2012: 1
- FWCI
- 2.25
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Johns Hopkins University
- National Cancer Institute (CA06973)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Oncology › Neutropenia and Cancer Infections
- Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
- Keywords
- total iron binding capacity, fungal infection, acute leukemia, granulocytopenia, chemotherapy-induced neutropenia, iron metabolism, amphotericin B, antifungal therapy, infection risk prediction, empirical antifungal therapy
- MeSH terms
- Acute Disease, Adult, Aged, Agranulocytosis, Amphotericin B, Blood Transfusion, Disease Susceptibility, Humans, Iron, Leukemia, Middle Aged, Mycoses, Protein Binding, Risk, Transferrin, Erythrocyte Transfusion, Platelet Transfusion
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