Therapeutic drug monitoring of posaconazole in patients with acute myeloid leukaemia: a pilot study of a monocentric experience

Abstract

Correspondence: Rosa Fanci Department of Haematology Careggi University Hospital of Florence, Italy E-mail: rosa.fanci@unifi.it SUMMARY The aim of this study was to evaluate the posaconazole (PCZ) plasma levels in the presence of patient-specific factors and the possible correlation between plasma levels and the clinical outcome in acute myeloid leukaemia (AML) patients. Acceptable levels for prophylaxis are ≥0.5 mg/L, although levels >0.7 mg/L have been recommended. Twenty-two AML patients in first-induction were included, receiving posaconazole as primary prophylaxis (200 mg/tid). The PCZ mean levels in 15 samples, obtained after 5-7 days, were 0.49±0.6 mg/L and in 34, obtained within 8-15 days, were 1.03±0.78 mg/L. The failure to reach adequate levels was related mainly to the use of proton-pump inhibitors or to poor compliance. Antifungal therapy was needed in 27% of patients, all with inadequate levels. No breakthrough aspergillosis was documented. In our experience, therapeutic drug monitoring seemed helpful to identify PCZ low concentrations and to optimise the treatment strategy. Therapeutic drug monitoring of posaconazole in patients with acute myeloid leukaemia: a pilot study of a monocentric experience