Abstract
Objective:Invasive fungal infections (IFIs) are a significant cause of morbidity and mortality among neutropenic patients undergoing chemotherapy for acute myeloid leukemia (AML) and stem cell transplantation. The aim of this study was to evaluate the real-life impact of posaconazole prophylaxis.Materials and Methods:Eighty-four adult patients were included with AML under remission induction chemotherapy and posaconazole prophylaxis. The 34 patients in the control group did not receive primary antifungal prophylaxis. The period between June 2006 and January 2009, when antifungal prophylaxis was not administered (control group), was retrospectively compared to the period between December 2010 and May 2012 when primary oral posaconazole prophylaxis was administered in similar conditions (posaconazole group) according to the use of antifungal agents for treatment, breakthrough infections, galactomannan performance, and the necessity for performing bronchoalveolar lavage (BAL) procedures.Results:The two groups were compared according to the use of antifungal agents; progression to a different antifungal agent was found in 34/34 patients (100%) in the control group and in 9/84 patients (11%) in the posaconazole group (p<0.001). There were four breakthrough IFIs (4/84, 4.8%) in the posaconazole group and 34 IFIs in the control group (p<0.001). In addition, 15/34 patients (44%) in the control group required BAL compared to 11/84 patients (13%) in the posaconazole group (p<0.001). Posaconazole treatment was discontinued within 7-14 days in 7/84 patients (8.3%) due to poor oral compliance related to mucositis after chemotherapy.Conclusion:Posaconazole appears to be effective and well-tolerated protection against IFIs for AML patients.
Highlights
Invasive fungal infections (IFIs) are a significant cause of morbidity and mortality among neutropenic patients undergoing chemotherapy for acute myeloid leukemia (AML) and stem cell transplantation
Posaconazole treatment was discontinued within 7-14 days in 7/84 patients (8.3%) due to poor oral compliance related to mucositis after chemotherapy
Posaconazole has been recommended as the drug of choice for AML patients undergoing induction chemotherapy based on the results of randomized controlled trials [4,5,6,7,8]
Summary
Invasive fungal infections (IFIs) are a significant cause of morbidity and mortality among neutropenic patients undergoing chemotherapy for acute myeloid leukemia (AML) and stem cell transplantation. The use of mold-specific prophylaxis has increased in recent years, in AML patients, because of the high mortality rate of IFIs [1,2,3]. Posaconazole has been recommended as the drug of choice for AML patients undergoing induction chemotherapy based on the results of randomized controlled trials [4,5,6,7,8]. Patients under posaconazole prophylaxis who were followed from 2010 to 2012 were compared with historical control patients without posaconazole prophylaxis who were followed from 2006 to 2009 in similar conditions according to the use of antifungal agents for treatment, breakthrough infections, galactomannan (GM) performance, and the requirement for bronchoalveolar lavage (BAL) procedures
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