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Posaconazole prophylaxis in patients with acute myelogenous leukaemia--results from an observational study

G Egerer1, M J P Geist

  • 1Medizinische Klinik V, University Hospital Heidelberg, Heidelberg, Germany. gerlinde.egerer@med.uni-heidelberg.de

Mycoses
|December 4, 2010
PubMed

Insights

Posaconazole prophylaxis effectively protected acute myelogenous leukemia (AML) patients from invasive fungal disease (IFD) during chemotherapy. This study found no fatal cases, indicating posaconazole prophylaxis is a well-tolerated and effective protective measure for AML patients.

Area of Science:

  • Hematology
  • Infectious Diseases
  • Pharmacology

Background:

  • Patients with acute myelogenous leukemia (AML) undergoing chemotherapy and experiencing neutropenia face a high risk of life-threatening invasive fungal disease (IFD).
  • Invasive aspergillosis (IA) is a particularly concerning IFD in this vulnerable patient population.

Purpose of the Study:

  • To evaluate the characteristics, risk factors, complications, and additional antifungal treatments in AML patients receiving posaconazole prophylaxis (PP) post-chemotherapy.
  • To assess the effectiveness and tolerability of posaconazole prophylaxis in a real-world clinical setting for AML patients.

Main Methods:

  • A retrospective, single-center observational study involving 40 AML patients (median age 66 years).
  • Posaconazole prophylaxis (200 mg three times daily) was administered routinely after remission induction chemotherapy.
  • Data collected included patient characteristics, risk factors for IFD, occurrence of IFD, fever, pneumonia, and subsequent antifungal treatments.

Main Results:

  • No fatal cases of IFD occurred during 76 chemotherapy cycles followed by PP (median duration 31 days).
  • The majority of patients had at least one additional risk factor for IFD; 42.1% had three risk factors.
  • Fever of unknown origin occurred in 52.6% of cycles, and pneumonia in 30.3%, with only one confirmed case of IA (1.3%).
  • PP was interrupted in 32.9% of cycles, with subsequent systemic antifungal therapy initiated in these cases.

Conclusions:

  • Posaconazole prophylaxis demonstrates effectiveness in preventing fatal invasive fungal disease in AML patients under natural clinical conditions.
  • The prophylaxis was well-tolerated, with a low incidence of proven invasive aspergillosis despite multiple risk factors present in the patient cohort.

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