Posaconazole prophylaxis during front-line chemotherapy of acute myeloid leukemia: a single-center, real-life experience

Abstract

The online version of this article has a Supplementary Appendix. BackgroundPosaconazole is effective as primary antifungal prophylaxis of invasive fungal diseases in patients with acute myeloid leukemia. Design and MethodsThe impact of primary antifungal prophylaxis administered during front-line chemotherapy for acute myeloid leukemia was evaluated by comparing 58 patients who received oral amphotericin B (control group) to 99 patients who received oral posaconazole (posaconazole group). The primary endpoint was the incidence of proven/probable invasive fungal diseases. Secondary endpoints included incidence of invasive aspergillosis, survival at 4 and 12 months after the diagnosis of acute myeloid leukemia and costs. ResultsProven/probable invasive fungal diseases were documented in 51.7% of patients in the control group and in 23.2% in the posaconazole group (P=0.0002). Invasive aspergillosis was documented in 43% of patients in the control group and in 15% in the posaconazole group (P=0.002). No survival difference was observed in patients aged over 60 years. In patients aged 60 years or less, a statistically significant survival advantage was observed at 4 months, but no longer at 12 months, in the posaconazole group (P=0.03). It was calculated that in the posaconazole group there was a mean 50% cost reduction for the antifungal drugs. ConclusionsPrimary antifungal prophylaxis with posaconazole during front-line chemotherapy was effective in preventing invasive fungal diseases in a "real-life" scenario of patients with acute myeloid leukemia, resulted in an early but transitory survival advantage in younger patients and was economically advantageous.

Incidence Density of Invasive Fungal Infections during Primary Antifungal Prophylaxis in Newly Diagnosed Acute Myeloid Leukemia Patients in a Tertiary Cancer Center, 2009 to 2011

“…The incidence of documented IFIs (definite or probable, according to revised European Organization for Research and Treatment of Cancer [EORTC] criteria) has been reported to range from 12 to 34% in patients with AML (4)(5)(6)(7)(8)(9)(10). In contrast, lower rates of 2 to 6% have been reported for selected patients with AML/myelodysplastic syndrome (MDS) who were enrolled in clinical trials of antifungal prophylaxis (11)(12)(13).…”

Prognostic Factors and Survival in Acute Myeloid Leukemia Cases: a Report from the Northeast of Iran

“…Because of the increasing prevalence and changing microbiological spectrum of invasive fungal infections, some form of amphotericin B still provides dependable and broad spectrum therapeutic alternative (Hamill, 2013). Invasive fungal diseases cause morbidity and mortality in patients with AML (Girmenia et al, 2012). Amphotericin B associates with reducing of neutropenic fever in the majority of patients (Spitzer et al, 1989).…”

A Single Center Experience for Antifungal Prophylaxis in Patients with Acute Myelogenous Leukemia

“…However, factors such as epidemiologic features of the center, duration of neutropenia or response to the treatment for AML can influence the incidence of IFDs along with the type of the antifungal prophylaxis. Recently, a prospective observational study reported no difference in the incidence of IFDs in AML patients receiving remission-induction or consolidation therapy regarding to the type of AFP contrast to numerous studies in this field [6][7][8][9][10]. Also, a study from Turkey which included 50 patients with AML did not find any difference between posaconazole and fluconazole in terms of AFP failure [11].…”