Temporary Glucose − 6 phosphate dehydrogenase enzyme deficiency, an additional risk factor for invasive fungal infection in immune-compromised AML patients

Invasive fungal infections (IFI) represent a major threat to acute myeloid leukemia (AML) patients, especially after induction chemotherapy. Intense chemotherapeutic drugs further weaken the immune function of AML patients which increases their susceptibility to life-threatening fungal infection, including invasive aspergillosis (IA). At present, there is no single reliable serological marker or method to predict accurately the risk of IA after induction chemotherapy. We hypothesized that some anti-cancer medicines and antibiotics may trigger temporary Glucose-6-Phosphate Dehydrogenase (G6PD) level which may increase the risk of fungal infection. In this study, we found that the serum galactomannan (GM) level was high in AML patients during IA and decreased in patients who recovered from IA. Along with the serum GM level, the level of G6PD was measured during IA and recovery. We found that AML patients had reduced serum G6PD levels during IA and experienced restoration of G6PD levels upon recovery in paired samples. Interleukin-6 (IL-6) was found to be higher in serum during fungal infection and positively correlated with the level of lactate dehydrogenase (LDH). Overall, monitoring G6PD levels along with IL-6 and GM in serum may be helpful in predicting IFI in AML patients.