Related Experiment Video
Updated: Sep 16, 2025
Live Imaging of Antifungal Activity by Human Primary Neutrophils and Monocytes in Response to A. fumigatus
Published on: April 19, 2017
Caspofungin for Primary Antifungal Prophylaxis in Acute Myeloid Leukemia: A Real-Life Study from an Academic Center
Francesco Grimaldi1, Mara Memoli1, Simona Avilia1
1Department of Clinical Medicine and Surgery, Hematology Division, University of Napoli "Federico II", 80131 Naples, Italy.
Abstract:
Background: Invasive fungal infections (IFIs) are a major complication in patients with acute myeloid leukemia (AML), particularly during chemotherapy-induced neutropenia. Posaconazole is the standard drug for primary antifungal prophylaxis (PAP), but its use is limited by oral bioavailability and CYP3A4 interactions. Study Objective: This study aims to evaluate the clinical efficacy and safety of intravenous caspofungin versus oral posaconazole as PAP in AML patients during their first cycle of chemotherapy and assess their subsequent impact on clinical outcomes. Methods: A retrospective, monocentric study was conducted on 75 consecutive AML patients treated at the Federico II University Medical School of Naples, Italy (2021-2025). Patients received either caspofungin or posaconazole as PAP based on the drug-drug interaction risk or clinical conditions. IFIs were diagnosed using EORTC/MSG criteria. Logistic and Cox regression models were used to assess risk factors and overall survival (OS). Results: IFI incidence was 13.3% overall (9.4% proven/probable). No significant difference was found between the caspofungin and posaconazole groups (six vs. four IFIs; p = 0.878). Post-chemotherapy refractory AML (OR = 11.9; p = 0.003) and liver disease (OR = 30.4; p = 0.004) independently predicted IFI development. Median OS did not significantly differ in patients receiving caspofungin versus posaconazole (29.3 vs. 32.1 months, p = 0.6). Conclusions: Caspofungin appears clinically comparable to posaconazole for PAP in AML during the induction phase, especially when azole use is contraindicated. Prospective studies are warranted to refine prophylactic strategies in the era of new AML therapies.
Insights
Intravenous caspofungin is comparable to oral posaconazole for preventing invasive fungal infections in acute myeloid leukemia patients during chemotherapy. This finding supports caspofungin use when azoles are contraindicated.
Area of Science:
- Hematology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Invasive fungal infections (IFIs) pose a significant risk for acute myeloid leukemia (AML) patients undergoing chemotherapy-induced neutropenia.
- Posaconazole, a standard for primary antifungal prophylaxis (PAP), has limitations including oral bioavailability and drug interactions (CYP3A4).
Purpose of the Study:
- To compare the clinical efficacy and safety of intravenous caspofungin versus oral posaconazole for PAP in AML patients during induction chemotherapy.
- To assess the impact of these prophylactic agents on overall survival (OS) in AML patients.
Main Methods:
- Retrospective monocentric study of 75 AML patients (2021-2025) receiving either caspofungin or posaconazole for PAP.
- IFIs diagnosed per EORTC/MSG criteria; logistic and Cox regression models analyzed risk factors and OS.
- Patient selection for caspofungin or posaconazole was based on drug-drug interaction risk or clinical status.
Main Results:
- Overall IFI incidence was 13.3% (9.4% proven/probable) with no significant difference between caspofungin and posaconazole groups (p=0.878).
- Refractory AML post-chemotherapy (OR=11.9; p=0.003) and liver disease (OR=30.4; p=0.004) were independent predictors of IFI.
- Median OS did not differ significantly between the groups (29.3 months for caspofungin vs. 32.1 months for posaconazole; p=0.6).
Conclusions:
- Intravenous caspofungin demonstrates clinical comparability to oral posaconazole for PAP in AML patients during induction therapy.
- Caspofungin is a viable alternative, particularly when azole antifungals are contraindicated due to drug interactions or clinical factors.
- Further prospective studies are needed to optimize prophylactic strategies in AML, especially with evolving treatment landscapes.
