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Published on: April 19, 2017
A Single Center Experience for Antifungal Prophylaxis in Patients with Acute Myelogenous Leukemia
Gökhan Metan1, Zeynep Türe1, Çiğdem Pala2
1Department of Infectious Diseases and Clinical Microbiology, Gevher Nesibe Hastanesi, Enfeksiyon Hastaliklari Klinigi, Erciyes Universitesi Tip Fakultesi, Kat:10 Talas Yolu, 38039 Kayseri, Turkey.
Abstract:
We aimed to provide real-life information about the effectivity of different types of primary antifungal prophylaxis (AFP) in patients with acute myeloid leukemia (AML). Records of AML patients who received remission-induction chemotherapy between June 2010 and February 2013 were retrospectively reviewed. A total of 85 AML remission-induction chemotherapy cycles were identified in 80 patients. Fluconazole prophylaxis (FP) was administered in 29 cycles, and posaconazole prophylaxis was given in 56 cycles. Failure in the AFP was observed in 45 (57.9 %) out of 85 cycles. Any type of invasive fungal diseases were detected in 15 (26.8 %) out of 56 cycles receiving posaconazole and 15 (51.7 %) out of 29 cycles receiving fluconazole (p = 0.023). Relapsing or refractory AML, longer duration of neutropenia and FP were more common in patients with AFP failure. Multivariate logistic regression analysis showed that type of AFP (odds ratio (OR) 3.63; 95 % confidence interval (CI) 1.19-11.07), presence of neutropenia longer than 21 days (OR 3.96; 95 % CI 1.36-11.46), and refractory or relapsing AML (OR 6.09; 95 % CI 2.09-17.73) were independent factors associated with failure of AFP. We observed superiority of posaconazole on fluconazole in the prophylaxis of AML patients receiving remission-induction chemotherapy.
Insights
Posaconazole is more effective than fluconazole for primary antifungal prophylaxis in acute myeloid leukemia (AML) patients undergoing chemotherapy. This study highlights posaconazole
Area of Science:
- Hematology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Acute myeloid leukemia (AML) patients undergoing remission-induction chemotherapy are at high risk for invasive fungal infections.
- Primary antifungal prophylaxis (AFP) is crucial in managing this risk.
- Real-world data on the comparative effectiveness of different AFP agents in AML is limited.
Purpose of the Study:
- To compare the effectiveness of fluconazole prophylaxis (FP) versus posaconazole prophylaxis in AML patients receiving remission-induction chemotherapy.
- To identify factors associated with antifungal prophylaxis failure in this patient population.
Main Methods:
- Retrospective review of 85 chemotherapy cycles in 80 AML patients (June 2010 - February 2013).
- Patients received either fluconazole (29 cycles) or posaconazole (56 cycles) as primary antifungal prophylaxis.
- Analysis of antifungal prophylaxis failure rates and associated clinical factors.
Main Results:
- Antifungal prophylaxis failure occurred in 57.9% of cycles.
- Invasive fungal disease incidence was significantly lower with posaconazole (26.8%) compared to fluconazole (51.7%; p=0.023).
- Independent factors for AFP failure included type of AFP, duration of neutropenia (>21 days), and relapsing/refractory AML.
Conclusions:
- Posaconazole demonstrated superior efficacy over fluconazole for primary antifungal prophylaxis in AML patients undergoing induction chemotherapy.
- Neutropenia duration and disease status are critical factors influencing antifungal prophylaxis outcomes.
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