Skip to main content
Log in

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

  • Original Article
  • Published:
Indian Journal of Hematology and Blood Transfusion Aims and scope Submit manuscript

Abstract

We aimed to provide real-life information about the effectivity of different types of primary antifungal prophylaxis (AFP) in patients with acute myeloid leukemia (AML). Records of AML patients who received remission-induction chemotherapy between June 2010 and February 2013 were retrospectively reviewed. A total of 85 AML remission-induction chemotherapy cycles were identified in 80 patients. Fluconazole prophylaxis (FP) was administered in 29 cycles, and posaconazole prophylaxis was given in 56 cycles. Failure in the AFP was observed in 45 (57.9 %) out of 85 cycles. Any type of invasive fungal diseases were detected in 15 (26.8 %) out of 56 cycles receiving posaconazole and 15 (51.7 %) out of 29 cycles receiving fluconazole (p = 0.023). Relapsing or refractory AML, longer duration of neutropenia and FP were more common in patients with AFP failure. Multivariate logistic regression analysis showed that type of AFP (odds ratio (OR) 3.63; 95 % confidence interval (CI) 1.19–11.07), presence of neutropenia longer than 21 days (OR 3.96; 95 % CI 1.36–11.46), and refractory or relapsing AML (OR 6.09; 95 % CI 2.09–17.73) were independent factors associated with failure of AFP. We observed superiority of posaconazole on fluconazole in the prophylaxis of AML patients receiving remission-induction chemotherapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Pagano L, Caira M, Candoni A (2006) The epidemiology of fungal infections in patients with hematological malignancies: the SEIFEM-2004 study. Haematologica 91:1068–1075

    PubMed  Google Scholar 

  2. Michallet M, Bénet T, Sobh M, Kraghel S, El Hamri M, Cannas G, Nicolini FE, Labussière H, Ducastelle S, Barraco F, Thomas X, Chelghoum Y, Nicolle MC, Bienvenu AL, Persat F, De Monbrison F, Picot S, Vanhems P (2011) Invasive aspergillosis: an important risk factor on the short- and long-term survival of acute myeloid leukemia (AML) patients. Eur J Clin Microbiol Infect Dis 31:991–997

    Article  PubMed  Google Scholar 

  3. Katragkou A, Tsikopoulou F, Roilides E, Zaoutis ET (2011) Posaconazole: when and how? The clinician’s view. Mycoses 55:110–122

    PubMed  Google Scholar 

  4. Cornely OA, Maertens J, Winston DJ, Perfect J, Ullmann AJ, Walsh TJ, Helfgott D, Holowiecki J, Stockelberg D, Goh YT, Petrini M, Hardalo C, Suresh R, Angulo-Gonzalez D (2007) Posaconazole versus fluconazole or itraconazole prophylaxis in patients with neutropenia. New Engl J Med 356:348–359

    Article  CAS  PubMed  Google Scholar 

  5. Maertens J, Marchetti O, Herbrecht R, Cornely OA, Flückiger U, Frêre P, Gachot B, Heinz WJ, Lass-Flörl C, Ribaud P, Thiebaut A, Cordonnier C (2011) European guidelines for antifungal management in leukemia and hematopoietic stem cell transplant recipients: summary of the ECIL 3--2009 update. Bone Marrow Transpl 46:709–718

    Article  CAS  Google Scholar 

  6. Bertz H, Drognitz K, Lübbert M (2013) No difference between posaconazole and fluconazole antifungal prophylaxis and mycological diagnostics except costs in patients undergoing AML chemotherapy: a 1-year “real-life” evaluation. Ann Hematol Epub DOI 10.1007/s00277-013-1854-6

  7. Pagano L, Caira M, Candoni A, Aversa F, Castagnola C, Caramatti C, Cattaneo C, Delia M, De Paolis MR, Di Blasi R, Di Caprio L, Fanci R, Garzia M, Martino B, Melillo L, Mitra ME, Nadali G, Nosari A, Picardi M, Potenza L, Salutari P, Trecarichi EM, Tumbarello M, Verga L, Vianelli N, Busca A, SEIFEM Group (2012) Evaluation of the practice of antifungal prophylaxis use in patients with newly diagnosed acute myeloid leukemia: results from the SEIFEM 2010-B registry. Clin Infect Dis 55:1515–1521

    Article  CAS  PubMed  Google Scholar 

  8. Girmenia C, Frustaci AM, Gentile G, Minotti C, Cartoni C, Capria S, Trisolini SM, Matturro A, Loglisci G, Latagliata R, Breccia M, Meloni G, Alimena G, Foà R, Micozzi A (2012) Posaconazole prophylaxis during front-line chemotherapy of acute myeloid leukemia: a single-center, real-life experience. Haematologica 97:560–567

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Peterson L, Ostermann J, Rieger H, Ostermann H, Rieger CT (2013) Posaconazole prophylaxis—impact on incidence of invasive fungal disease and antifungal treatment in haematological patients. Mycoses 56:651–658

    Article  CAS  PubMed  Google Scholar 

  10. Shen Y, Huang XJ, Wang JX, Jin J, Hu JD, Yu K, Wu DP, Wang SJ, Yu L, Chen XQ, Liu T, Liang YM, Chen FP, Li Y, Shen ZX (2013) Posaconazole versus fluconazole as invasive fungal infection prophylaxis in China: a multicenter, randomized, open-label study. Int J Clin Pharmacol Ther 51:738–745

    Article  CAS  PubMed  Google Scholar 

  11. Kaya S, Sonmez M, Koksal I, Gencalioglu E, Yilmaz M, Yilmaz G (2014) Comparison of fluconazole and posaconazole for fungal prophylaxis in high risk patients with hematological malignity. J Microbiol Infect Dis 4:1–6

    Article  Google Scholar 

  12. Metan G, Koç AN, Atalay A, Kaynar LG, Ozturk A, Alp E, Eser B (2012) What should be the optimal cut-off of serum 1,3-β-d-glucan for the detection of invasive pulmonary aspergillosis in patients with haematological malignancies? Scand J Infect Dis 44:330–336

    Article  CAS  PubMed  Google Scholar 

  13. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, Pappas PG, Maertens J, Lortholary O, Kauffman CA, Denning DW, Patterson TF, Maschmeyer G, Bille J, Dismukes WE, Herbrecht R, Hope WW, Kibbler CC, Kullberg BJ, Marr KA, Muñoz P, Odds FC, Perfect JR, Restrepo A, Ruhnke M, Segal BH, Sobel JD, Sorrell TC, Viscoli C, Wingard JR, Zaoutis T, Bennett JE (2008) Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group. Clin Infect Dis 46:1813–1821

    Article  PubMed Central  PubMed  Google Scholar 

  14. Segal BH, Herbrecht R, Stevens DA, Ostrosky-Zeichner L, Sobel J, Viscoli C, Walsh TJ, Maertens J, Patterson TF, Perfect JR, Dupont B, Wingard JR, Calandra T, Kauffman CA, Graybill JR, Baden LR, Pappas PG, Bennett JE, Kontoyiannis DP, Cordonnier C, Viviani MA, Bille J, Almyroudis NG, Wheat LJ, Graninger W, Bow EJ, Holland SM, Kullberg BJ, Dismukes WE, De Pauw BE (2008) Defining responses to therapy and study outcomes in clinical trials of invasive fungal diseases: mycoses Study Group and European Organization for Research and Treatment of Cancer Consensus Criteria. Clin Infect Dis 47:674–683

    Article  PubMed Central  PubMed  Google Scholar 

  15. de Pauw BE, Sable CA, Walsh TJ, Lupinacci RJ, Bourque MR, Wise BA, Nguyen BY, DiNubile MJ, Teppler H (2006) Impact of alternate definitions of fever resolution on the composite endpoint in clinical trials of empirical antifungal therapy for neutropenic patients with persistent fever: analysis of results from the Caspofungin Empirical Therapy Study. Transpl Infect Dis 8:31–37

    Article  PubMed  Google Scholar 

  16. Dolton MJ, Ray JE, Chen SC, Ng K, Pont L, McLachlan AJ (2012) A multi-center study of posaconazole therapeutic drug monitoring: exposure-response and factors affecting concentration. Antimicrob Agents Chemother 56:5503–5510

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Pagano L, Verga L, Busca A, Martino B, Mitra ME, Fanci R, Ballanti S, Picardi M, Castagnola C, Cattaneo C, Nadali G, Nosari A, Candoni A, Caira M, Salutari P, Lessi F, Aversa F, Tumbarello M (2014) Systemic antifungal treatment after posaconazole prophylaxis: results from the SEIFEM 2010-C survey. J Antimicrob Chemother 69:3142–3147

    Article  CAS  PubMed  Google Scholar 

  18. Maschmeyer G, Patterson TF (2014) Our 2014 approach to breakthrough invasive fungal infections. Mycoses doi:10.1111/myc.12213

  19. Nosari AM, Caira M, Pioltelli ML, Fanci R, Bonini A, Cattaneo C, Castagnola C, Capalbo SF, De Fabritiis P, Mettivier V, Morselli M, Pastore D, Aversa F, Rossi G, Pagano L (2013) Hema e-Chart Group, Italy. Hema e-Chart registry of invasive fungal infections in haematological patients: improved outcome in recent years in mould infections. Clin Microbiol Infect 19:757–762

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

G.M. has received honorarium for speaking at symposia and lecture organized by Gilead, financial compensation from Pfizer for the time and expenses for a meeting organised to discuss the content of a review paper, received research support from Associates of Cape Cod, and received travel grants form MSD, Pfizer, and Gilead to participate conferences. L.K has received honorarium for speaking at a lecture organized by Gilead. The other authors declared to have any completing interest. No funding was received for this study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gökhan Metan.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Metan, G., Türe, Z., Pala, Ç. et al. A Single Center Experience for Antifungal Prophylaxis in Patients with Acute Myelogenous Leukemia. Indian J Hematol Blood Transfus 31, 339–345 (2015). https://doi.org/10.1007/s12288-014-0472-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12288-014-0472-3

Keywords

Navigation