Evaluation of the implementation rate of primary antifungal prophylaxis and the prognosis of invasive fungal disease in acute leukemia patients in China

Xu, Xiangyu; Zhang, Lu; Cao, Xinxin; Li, Jian; Zhang, Wei; Zhu, Tienan; Cai, Huacong; Chen, Miao; Han, Xiao; Chen, Yang; Han, Bing; Zhang, Yan; Zhuang, Junling; Zhou, Daobin; Duan, Minghui

doi:10.1016/j.jiac.2017.02.011

Cited by 19 publications

(15 citation statements)

References 53 publications

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“…Our literature search identified seven studies with a total of 818 patients who received posaconazole for antifungal prophylaxis in leukemic patients, included patients with comparable primary diagnosis and age, and assessed proven or probable IFIs. 13,21,25,[29][30][31][32] The literature-based weighted mean incidence of IFI in posaconazole patients was determined to be 2.4% (Table 4) and was similar to the risk of developing an IFI in study patients who received voriconazole (3.3%; p ¼ 0.5).…”

Section: Proven or Probable Ifismentioning

confidence: 82%

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Voriconazole prophylaxis in leukemic patients: A retrospective single-center study

Bui

Walker

Elligsen

et al. 2019

J Oncol Pharm Pract

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Background Invasive fungal infections commonly occur in acute myeloid and lymphoblastic leukemia patients receiving chemotherapy. In these patients with acute leukemia, posaconazole prophylaxis is recommended; however, voriconazole may be a less costly alternative. Objectives The objective of this study was to evaluate the efficacy and safety of voriconazole prophylaxis in acute leukemia patients. Methods A retrospective chart review of inpatients at Sunnybrook Health Sciences Centre between 2005 and 2017 was completed. Hospitalized adult acute leukemia patients who received voriconazole prophylaxis (cases) were compared to patients who received fluconazole or no prophylaxis during chemotherapy (controls). Statistical analyses comparing baseline characteristics, safety, and efficacy outcomes between the study cohorts were completed. A posaconazole literature-based weighted mean risk was compared to the voriconazole risk of invasive fungal infection identified in this study. Results Of 490 acute myeloid leukemia or acute lymphoblastic leukemia patients, 83 controls and 92 cases were eligible. Case patients received an average of 24.4 ± 10.8 days of voriconazole prophylaxis. The incidence of proven or probable invasive fungal infections with voriconazole was 3.3% (3/92) versus 7.2% (6/83) in the control cohort (p > 0.05) and was comparable to the literature reported weighted incidence of invasive fungal infection with posaconazole (2.4 ± 2.1%; 95% CI 1.3%–3.4%; p > 0.05). Voriconazole was well tolerated by patients (91%; 84/91; seven discontinued due to asymptomatic elevated liver function tests). Conclusions Voriconazole prophylaxis was found to be safe, effective, and comparable to literature-based efficacy data for risk of invasive fungal infection with posaconazole antifungal prophylaxis in patients with acute leukemia undergoing chemotherapy and could represent a significant cost advantage.

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Section: Proven or Probable Ifismentioning

confidence: 82%

“…The literature-based weighted incidence of IFIs was calculated based on the sample size of each published study that reported the incidence of IFI with posaconazole. 13,21,25,[29][30][31][32] Descriptive statistics were calculated for all variables of interest. Means and standard deviations were used to describe interval data.…”

Section: Statisticsmentioning

confidence: 99%

Voriconazole prophylaxis in leukemic patients: A retrospective single-center study

Bui

Walker

Elligsen

et al. 2019

J Oncol Pharm Pract

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“…This study showed that antifungal prophylaxis with posaconazole significantly reduced IFIs and the need for antifungal treatment. Several recent studies supported the finding that posaconazole prophylaxis reduces the incidence of IFIs and invasive aspergillus in patients with AML/MDS or hematopoietic cell transplantation recipients when tested against comparable antifungal agents [ 16 , 17 , 18 ]. Prophylactic posaconazole was associated with statistically significantly fewer febrile days, shorter duration of hospitalization, and longer fungal-free survival; however, overall and attributable mortality did not differ [ 19 ].…”

Section: Discussionmentioning

confidence: 92%

The Outcome of Antifungal Prophylaxis with Posaconazole in Patients with Acute Myeloid Leukemia: A Single Center Study

Özkocaman

Özkalemkaş

Seyhan

et al. 2018

Tjh

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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.

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“…AML cells were clinically heterogeneous and their progenitor cells have a self-renewal potential to generate the bulk of leukemia cells (3,4). The incidence and mortality are gradually increasing in developing countries (5). In China, the incidence of AML is the highest among young patients (5).…”

Section: Introductionmentioning

confidence: 99%

“…The incidence and mortality are gradually increasing in developing countries (5). In China, the incidence of AML is the highest among young patients (5). Chemotherapy consisting paclitaxel, cisplatin or others is the main approach for AML treatment (6).…”

Section: Introductionmentioning

confidence: 99%

Downregulation of miR‑135a predicts poor prognosis in acute myeloid leukemia and regulates leukemia progression via modulating HOXA10 expression

Wen

2018

Mol Med Report

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MicroRNA‑135a (miR‑135a) has been shown to exert important roles in various human cancer types, such as glioblastoma, thyroid carcinoma and renal carcinoma. However, the function of miR‑135a in acute myeloid leukemia (AML) remains largely unknown. In the present study, it was demonstrated that miR‑135a expression was significantly downregulated in AML cells compared with normal control cells. Furthermore, the downregulation of miR‑135a in patients with AML predicted poor prognosis. Through functional experiments, overexpression of miR‑135a was demonstrated to significantly inhibit the proliferation and cell cycle of AML cells, while it promoted cellular apoptosis. miR‑135a directly targeted HOXA10 in AML cells. miR‑135a overexpression significantly suppressed the mRNA and protein levels of HOXA10 in AML cells. Moreover, there was an inverse association between miR‑135a expression and HOXA10 level in AML samples. Additionally, by ectopic expression of HOXA10, restoration of HOXA10 significantly abolished the effects of miR‑135a overexpression on AML cell proliferation, cell cycle and apoptosis. In conclusion, the present study demonstrated that miR‑135a serves as a tumor suppressor in AML by targeting HOXA10, and miR‑135a may be a promising prognostic biomarker for AML patients.

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Evaluation of the implementation rate of primary antifungal prophylaxis and the prognosis of invasive fungal disease in acute leukemia patients in China

Cited by 19 publications

References 53 publications

Voriconazole prophylaxis in leukemic patients: A retrospective single-center study

Voriconazole prophylaxis in leukemic patients: A retrospective single-center study

The Outcome of Antifungal Prophylaxis with Posaconazole in Patients with Acute Myeloid Leukemia: A Single Center Study

Downregulation of miR‑135a predicts poor prognosis in acute myeloid leukemia and regulates leukemia progression via modulating HOXA10 expression

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