AML-202: A Single-Center Comparative Clinical Study of Prophylactic Antifungal Therapy of Voriconazole versus Posaconazole in Patients with Acute Myeloid Leukemia Undergoing Remission-Induction Therapy

Abstract

<h3>Context:</h3> Invasive fungal infections are the main cause of morbidity and mortality in patients with acute myeloid leukemia undergoing induction chemotherapy. Prophylaxis is a commonly used treatment strategy because delay in diagnosis and antifungal treatment increases mortality. Posaconazole is currently the preferred drug for fungal prophylaxis, but it is costly and inappropriate in certain resource-limited Indian settings. Both posaconazole and voriconazole have been used as antifungal prophylaxis, but there are very few studies comparing the efficacy of these two drugs. <h3>Objective:</h3> Primary objectives of the study were to identify invasive fungal infections (IFI), evaluate the requirement of EAFT and its duration, and compare them. Secondary objectives were to compare the induction mortalities and adverse effects of the drugs. <h3>Design:</h3> Retrospective observational study. All adult patients (>18 y) with AML undergoing induction chemotherapy in 3 consecutive years (2014–2016) whose complete clinical and treatment details were available were included in the study. <h3>Setting:</h3> The study was carried out at the Institute of Hematology and Transfusion Medicine, Kolkata, which is a tertiary care center for hematological diseases in East India. <h3>Results:</h3> Data for 67 AML patients (31 in voriconazole and 36 in posaconazole) were analyzed. The adoption of voriconazole as antifungal prophylaxis has resulted in a trend toward decreased incidence of breakthrough IFIs (1 <i>vs</i> 3) and the use of EAFT (23.07% <i>vs</i> 38.09%; p=0.067). All proven IFIs were invasive aspergillosis. Induction mortality rate (7 <i>vs</i> 5; p=0.27), and CR rate (80.76% <i>vs</i> 71.42%; p=0.15) are not statistically different. Drug intolerance is higher with voriconazole (9/31 <i>vs</i> 4/36; p=0.05), and 2 patients had premature discontinuation due to significant side effects. <h3>Conclusion:</h3> In our centre, evidence points toward decreased IFI and EAFT in patients with voriconazole prophylaxis as compared to posaconazole, albeit with some increased drug-related adverse effects. In a resource-limited centre, voriconazole may be a useful alternative to posaconazole as a prophylactic antifungal drug in acute myeloid leukemia.