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

Abstract

BACKGROUND:

Posaconazole is effective as primary antifungal prophylaxis of invasive fungal diseases in patients with acute myeloid leukemia.

DESIGN AND METHODS:

The 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.

RESULTS:

Proven/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.

CONCLUSIONS:

Primary 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.

• Authors: Corrado Girmenia, Anna Maria Frustaci, Giuseppe Gentile, Clara Minotti, Claudio Cartoni, Saveria Capria, Silvia Maria Trisolini, Angela Matturro, Giuseppina Loglisci, Roberto Latagliata, Massimo Breccia, Giovanna Meloni, Giuliana Alimena, Robin Foà, Alessandra Micozzi
• Journal: Haematologica (Haematologica) Vol. 97 Issue 4 Pg. 560-7 (Apr 2012) ISSN: 1592-8721 [Electronic] Italy
• PMID: 22102706 (Publication Type: Journal Article)

Chemical References

• Antifungal Agents
• Triazoles
• posaconazole

Topics

• Adult
• Aged
• Antibiotic Prophylaxis
• Antifungal Agents (administration & dosage, adverse effects, therapeutic use)
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Female
• Hospitalization (economics)
• Humans
• Leukemia, Myeloid, Acute (complications, drug therapy, mortality)
• Male
• Middle Aged
• Mycoses (economics, etiology, prevention & control)
• Survival Analysis
• Treatment Outcome
• Triazoles (administration & dosage, adverse effects, therapeutic use)
• Young Adult