Effectiveness of primary anti-Aspergillus prophylaxis during remission induction chemotherapy of acute myeloid leukemia.

Abstract

Although antifungal prophylaxis is frequently administered to patients with acute myeloid leukemia (AML) during remission-induction chemotherapy (RIC), its impact on reducing invasive fungal infections (IFIs) outside clinical trials is rarely reported. We performed a retrospective observational study to identify risk factors for development of IFIs (definite or probable, using revised European Organization for Research and Treatment of Cancer [EORTC] criteria) and all-cause mortality in a cohort of 152 AML patients receiving RIC (2009 to 2011). We also compared rates of IFI and mortality in patients who received echinocandin versus anti-Aspergillus azole (voriconazole or posaconazole) prophylaxis during the first 120 days of RIC. In multivariate analysis, clofarabine-based RIC (hazard ratio [HR], 3.5; 95% confidence interval [CI], 1.5 to 8.3; P = 0.004) and echinocandin prophylaxis (HR, 4.6; 95% CI, 1.8 to 11.9; P = 0.002) were independently associated with higher rates of IFI rates during RIC. Subsequent analysis failed to identify any malignancy- or chemotherapy-related covariates linked to echinocandin prophylaxis that accounted for the higher rates of breakthrough IFI. Although the possibility of other confounding variables cannot be excluded, our findings suggest that echinocandin-based prophylaxis during RIC for AML may be associated with a higher risk of breakthrough IFI.

• Authors: Marisa Z R Gomes, Ying Jiang, Victor E Mulanovich, Russell E Lewis, Dimitrios P Kontoyiannis
• Journal: Antimicrobial agents and chemotherapy (Antimicrob Agents Chemother) Vol. 58 Issue 5 Pg. 2775-80 (May 2014) ISSN: 1098-6596 [Electronic] United States
• PMID: 24590477 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antifungal Agents
• Echinocandins
• Triazoles
• posaconazole
• Voriconazole

Topics

• Aged
• Antifungal Agents (therapeutic use)
• Aspergillus (drug effects)
• Echinocandins (therapeutic use)
• Female
• Humans
• Induction Chemotherapy (methods)
• Leukemia, Myeloid, Acute (drug therapy)
• Male
• Middle Aged
• Retrospective Studies
• Risk Factors
• Triazoles (therapeutic use)
• Voriconazole (therapeutic use)