Antifungal Prophylaxis in AML Patients Receiving Intensive Induction Chemotherapy: A Prospective Observational Study From the Acute Leukaemia French Association (ALFA) Group

Michallet, Mauricette; Sobh, Mohamad; Deloire, Alexandre; Raffoux, Emmanuel; Botton, Stéphane de; Caillot, Denis; Reman, Oumédaly; Girault, Stéphane; Berthon, Céline; Huguet, Françoise; Leprêtre, Stéphane; Leguay, Thibaut; Castaigné, Sylvie; Royer, Bruno; Pautas, Cécile; Malfuson, Jean-Valère; Fernandes, José; Prébet, Thomas; Braun, Thorsten; Gastaud, Lauris; Suarez, Félipe; Schmidt, Aline; Gressin, Rémy; Delaunay, Jacques; Bonmati, Caroline; Celli-Lebras, Karine; Elhamri, Mohamed; Dombret, Hervé; Thomas, Xavier; Bergeron, Anne

doi:10.1016/j.clml.2021.10.011

Cited by 3 publications

(2 citation statements)

References 21 publications

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“…To the best of our knowledge, our study is the one with the largest PPC measurements. Overall, in 20.1% of chemotherapy treatments, the PPCs totaled <0.7 mg/L at one time-point (only 6.5% at two consecutive time-points), and this percentage is lower than that reported by several studies [44,49,112], possibly due to a more extensive use of tablet formulations, but still indicates considerable interpatient variability. Although there are concerns about the suboptimal efficacy of azoles in the context of neutropenia [113], the importance of achieving PPCs > 0.7 mg/L for prophylaxis and >1 mg/L for treatment [7,8,114], and the absence of a definite correlation between PPCs and toxicity, are well known [114,115].…”

Section: Resultsmentioning

confidence: 55%

“…In the setting of remission induction chemotherapy, the incidence of b-IFDs in patients receiving AFP, mainly with posaconazole, was between 2.2% and 5% [ 44 , 45 , 46 , 47 , 48 ]. Interestingly, the only study reporting a higher incidence (7.9%) still employed oral suspension, leading to low posaconazole plasma concentrations (PPCs) [ 49 ]. Other mold-active agents (e.g., voriconazole, isavuconazole, echinocandins) have been used with variable results.…”

Section: Invasive Fungal Diseases In Patients Undergoing Remission In...mentioning

confidence: 99%

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High-Risk Neutropenic Fever and Invasive Fungal Diseases in Patients with Hematological Malignancies

Mori,

Diotallevi,

Farina

et al. 2024

Microorganisms

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Invasive fungal diseases (IFDs) still represent a relevant cause of mortality in patients affected by hematological malignancies, especially acute myeloid leukaemia (AML) and myelodysplastic syndrome (MDS) undergoing remission induction chemotherapy, and in allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. Mold-active antifungal prophylaxis (MAP) has been established as a standard of care. However, breakthrough IFDs (b-IFDs) have emerged as a significant issue, particularly invasive aspergillosis and non-Aspergillus invasive mold diseases. Here, we perform a narrative review, discussing the major advances of the last decade on prophylaxis, the diagnosis of and the treatment of IFDs in patients with high-risk neutropenic fever undergoing remission induction chemotherapy for AML/MDS and allo-HSCT. Then, we present our single-center retrospective experience on b-IFDs in 184 AML/MDS patients undergoing high-dose chemotherapy while receiving posaconazole (n = 153 induction treatments, n = 126 consolidation treatments, n = 60 salvage treatments). Six cases of probable/proven b-IFDs were recorded in six patients, with an overall incidence rate of 1.7% (6/339), which is in line with the literature focused on MAP with azoles. The incidence rates (IRs) of b-IFDs (95% confidence interval (95% CI), per 100 person years follow-up (PYFU)) were 5.04 (0.47, 14.45) in induction (n = 2), 3.25 (0.0013, 12.76) in consolidation (n = 1) and 18.38 (3.46, 45.06) in salvage chemotherapy (n = 3). Finally, we highlight the current challenges in the field of b-IFDs; these include the improvement of diagnoses, the expanding treatment landscape of AML with molecular targeted drugs (and related drug–drug interactions with azoles), evolving transplantation techniques (and their related impacts on IFDs’ risk stratification), and new antifungals and their features (rezafungin and olorofim).

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Section: Resultsmentioning

confidence: 55%

Section: Invasive Fungal Diseases In Patients Undergoing Remission In...mentioning

confidence: 99%

High-Risk Neutropenic Fever and Invasive Fungal Diseases in Patients with Hematological Malignancies

Mori,

Diotallevi,

Farina

et al. 2024

Microorganisms

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show abstract

The impact of antifungal prophylaxis in patients diagnosed with acute leukemias undergoing induction chemotherapy: a systematic review and meta-analysis

et al. 2023

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Fluconazole and levofloxacin prophylaxis are ineffective strategies for preventing infections in acute myeloid leukemia patients undergoing chemotherapy

Soldi,

Silva

2024

Cancer Epidemiology

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Antifungal Prophylaxis in AML Patients Receiving Intensive Induction Chemotherapy: A Prospective Observational Study From the Acute Leukaemia French Association (ALFA) Group

Cited by 3 publications

References 21 publications

High-Risk Neutropenic Fever and Invasive Fungal Diseases in Patients with Hematological Malignancies

High-Risk Neutropenic Fever and Invasive Fungal Diseases in Patients with Hematological Malignancies

The impact of antifungal prophylaxis in patients diagnosed with acute leukemias undergoing induction chemotherapy: a systematic review and meta-analysis

Fluconazole and levofloxacin prophylaxis are ineffective strategies for preventing infections in acute myeloid leukemia patients undergoing chemotherapy

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