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Posaconazole prophylaxis during front-line chemotherapy of acute myeloid leukemia: a single-center, real-life

Corrado Girmenia1, Anna Maria Frustaci, Giuseppe Gentile

  • 1Dipartimento di Ematologia, Oncologia, Anatomia Patologica e Medicina Rigenerative, Azienda Policlinico Umberto I, Sapienza University of Rome Via Benevento 6, 00161 Rome, Italy. girmenia@bce.uniroma1.it

Haematologica
|November 22, 2011
PubMed
Abstract

Insights

Posaconazole significantly reduced invasive fungal diseases in acute myeloid leukemia patients undergoing chemotherapy. This antifungal prophylaxis offered an early survival benefit in younger patients and proved cost-effective.

Area of Science:

  • Hematology
  • Infectious Diseases
  • Pharmacology

Background:

  • Acute myeloid leukemia (AML) patients undergoing chemotherapy are at high risk for invasive fungal diseases (IFDs).
  • Primary antifungal prophylaxis is crucial for managing IFDs in this vulnerable population.

Purpose of the Study:

  • To evaluate the efficacy and economic impact of posaconazole versus oral amphotericin B for primary antifungal prophylaxis in AML patients.
  • To compare the incidence of IFDs, invasive aspergillosis, and survival rates between the two prophylaxis groups.

Main Methods:

  • A comparative study involving 99 patients receiving oral posaconazole and 58 patients receiving oral amphotericin B during front-line chemotherapy for AML.
  • Primary endpoint: incidence of proven/probable IFDs. Secondary endpoints: incidence of invasive aspergillosis, survival, and costs.

Main Results:

  • Posaconazole significantly reduced the incidence of IFDs (23.2% vs. 51.7%, P=0.0002) and invasive aspergillosis (15% vs. 43%, P=0.002) compared to amphotericin B.
  • A statistically significant early survival advantage was observed in patients aged 60 or less receiving posaconazole (P=0.03).
  • Posaconazole prophylaxis resulted in a mean 50% cost reduction for antifungal drugs.

Conclusions:

  • Posaconazole is an effective and economically advantageous strategy for primary antifungal prophylaxis in AML patients during chemotherapy.
  • Posaconazole demonstrated a significant reduction in IFDs and invasive aspergillosis in a real-world setting.
  • An early, albeit temporary, survival benefit was noted in younger patients treated with posaconazole.

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