Epidemiology of Infection in Acute Myeloid Leukaemia (EPIAMLINF) project update, March 2026

Infections remain the leading cause of morbidity and mortality in patients with Acute Myeloid Leukaemia (AML), primarily due to the profound and prolonged neutropenia caused by both the disease and its treatments. This EHA SWG Infections in Hematology-initiated registry was launched to address the evolving epidemiological landscape shaped by widespread antifungal prophylaxis, increasing antimicrobial resistance, and the introduction of novel, less intensive therapeutic regimens.

Study objectives and methodology

The primary goal of EPIAMLINF is to evaluate the incidence of bacterial, fungal, and viral infections in adult AML patients (≥18 years) during induction, consolidation, or salvage chemotherapy. The study specifically targets:

Inclusion criteria

Patients with newly diagnosed AML (between March 2025 and February 2026) followed for any new infection from diagnosis up to day +45.

Comprehensive data collection

The analysis includes AML subtypes, baseline laboratory status, comorbidities, specific antileukaemic treatments, and detailed infectious profiles (pathogens, imaging, and outcomes).

Geographical scope

The current cohort includes 389 patients across 13 countries, with major contributions from Italy (77.1%), Spain (6.2%), and Turkey (4.9%).

Evolving treatment and prophylaxis challenges

The project highlights a critical shift in AML care:

  • New therapies: The availability of drugs like venetoclax, FLT-3 inhibitors, and CPX-351, ivosidenib, glasdegib  has expanded treatment options but introduced complex drug-drug interactions, particularly with standard azole and fluoroquinolone prophylaxis.
  • Prophylaxis controversy: While posaconazole remains the standard for antifungal prophylaxis, the use of quinolones for bacteria is increasingly questioned due to rising resistance rates.
  • Targeted regimens: Data shows distinct treatment patterns across AML subtypes. For instance, Azacitidine + Venetoclax was used in 32.9% of AML cases defined by differentiation and 29.0% of therapy-related AML (t-AML).

Key preliminary findings

Initial data from the cohort reveals the high burden of infectious complications:

  • Pathogen profile: Bacterial pathogens continue to predominate, but coinfections are common and significantly complicate management.
  • Impact on mortality: Despite advances in leukaemic treatment that have improved overall survival, infection is still responsible for nearly one in two deaths in this population.
  • Clinical outcomes: The study tracks outcomes through day +46, analyzing the intersection of neutrophil recovery, infection resolution, and AML response across various subtypes like AML-myelodysplasia-related (AML-MR) and t-AML.

Conclusions and next steps

These findings underscore that “one-size-fits-all” infection management is no longer sufficient in the era of modern AML care. Future steps involve:

  • Risk stratification: Developing improved tools to identify which patients are at the highest risk for specific types of infections based on their AML subtype and treatment regimen.
  • Integrated management: Promoting closer collaboration between haematology and infectious disease specialists to manage resistance and prophylaxis.

This ongoing project provides the essential real-world evidence needed to refine clinical guidelines and improve survival for patients battling AML.

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