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Outcome of empirical or targeted antifungal therapy after antifungal prophylaxis in febrile neutropenia

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Abstract

Azole prophylaxis has been shown to be effective in preventing invasive fungal infections (IFIs) and increasing survival in patients with prolonged neutropenia after myelosuppressive chemotherapy for haematological malignancies. Similarly, empirical antifungal therapy for persistent neutropenic fever has been shown to reduce IFI-related mortality. However, to date, there is little information with regard to the outcome of patients who receive both strategies. Here, we present our retrospective data on three cohorts of patients receiving empirical or targeted antifungal therapy after different antifungal prophylaxis regimens. All records from patients who received myelosuppressive induction chemotherapy for acute myelogenous leukemia (AML) in our centre from 2004–2010 were analysed. From 2004–2006, itraconazole was used as antifungal prophylaxis; for the first 6 months in 2007, local polyenes and from mid-2007 till 2010, posaconazole. Data of 315 courses of chemotherapy in 211 patients were analysed. Antifungal therapy (empirical or targeted, time point and antifungal agent at the physician’s discretion) was initiated in 50/174 (29 %), 7/18 (39 %) and 34/123 courses (28 %, p = 0.615) in the itra cohort, the cohort without systemic prophylaxis and the posa cohort, respectively, and was effective in 24/50 (48 %), 5/7 (71 %) and 22/34 courses (65 %, p = 0.221), respectively. IFI occurred in 25/174 (14 %), 4/18 (22 %) and 16/123 (13 %) courses, respectively (p = 0.580). IFI-related survival was not different in the three cohorts. Antifungal treatment in patients with AML who received azole prophylaxis resulted in the expected efficacy—importantly, prior posaconazole prophylaxis did not render subsequent antifungal treatment less effective than prior itraconazole prophylaxis.

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Acknowledgments

This project was funded by a research grant from MSD Sharp and Dohme.

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Authors and Affiliations

  1. Medizinische Klinik und Poliklinik III, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany

    C. Hahn-Ast, L. Felder, K. Mayer, S. Mückter, K. Schwab, P. Brossart & M. von Lilienfeld-Toal

  2. Paracelsus-Klinik Osnabrück, Osnabrück, Germany

    M. Ruhnke

  3. Institut für Medizinische Statistik, Informatik und Epidemiologie, Universität zu Köln, Köln, Germany

    R. Hein & M. Hellmich

  4. Klinik für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Jena, Germany

    T. Rachow & M. von Lilienfeld-Toal

  5. Leibniz-Institut für Naturstoff-Forschung und Infektionsbiologie e.V., Hans-Knöll-Institut, Jena, Germany

    M. von Lilienfeld-Toal

  6. Center for Sepsis Control and Care (CSCC), Universitätsklinikum Jena, Jena, Germany

    M. von Lilienfeld-Toal

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  1. C. Hahn-Ast
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  2. L. Felder
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  3. K. Mayer
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  4. S. Mückter
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  5. M. Ruhnke
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  6. R. Hein
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  7. M. Hellmich
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  8. K. Schwab
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  9. T. Rachow
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  10. P. Brossart
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  11. M. von Lilienfeld-Toal
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Correspondence to C. Hahn-Ast.

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Conflict of interest

MvLT and CH-A have received research funding and honoraria from MSD Sharp and Dohme, Pfizer, Essex (now MSD Sharp and Dohme) and Gilead. MvLT is also a member of the advisory board of MSD. This had no influence on the design, analysis and interpretation of the study. The authors have full control of all primary data and are fully responsible for content and editorial decisions for this paper. All authors reviewed the manuscript and approved the final version.

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Hahn-Ast, C., Felder, L., Mayer, K. et al. Outcome of empirical or targeted antifungal therapy after antifungal prophylaxis in febrile neutropenia. Ann Hematol 95, 1001–1009 (2016). https://doi.org/10.1007/s00277-016-2630-1

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  • DOI: https://doi.org/10.1007/s00277-016-2630-1

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