VORICONAZOLE AS PRIMARY PROPHYLAXIS OF FUNGAL INFECTIONS IN HIGH-RISK HEMATOLOGIC PATIENTS: NO NEED FOR EMPIRICAL ANTI-FUNGAL THERAPY.
(Abstract release date: 05/19/16)
EHA Library. Zabalza A. 06/09/16; 132731; E1182
Dr. Amaya Zabalza
Contributions
Contributions
Abstract
Abstract: E1182
Type: Eposter Presentation
Background
Invasive fungal infections (IFI), predominantly aspergillosis and candidiasis, remain an important cause of morbidity and mortality following high-dose chemotherapy and allogeneic stem cell transplantation (alloSCT).
Aims
The primary endpoint of this study was to analysed the efficacy and safety of voriconazole primary antifungal prophylaxis in combination with a pre-emptive antifungal strategy in high-risk hematologic patients.
Methods
This is a retrospective, observational and non-interventional study conducted from March 2009 until February 2012 at the Complejo Hospitalario de Navarra. Patients could receive voriconazole prophylaxis at different periods of time in the course of their disease if they were at high-risk of IFI: following intensive chemotherapy (n=24), allogeneic stem cell transplantation (n=43) or receiving high-dose corticosteroids treatment for chronic graft versus host disease (n=11). If patients developed prolonged unresponsive fever after 5 days of broad-spectrum antibacterials and/or galactomannan antigen was positive, a high-resolution computed tomography (CT) was performed. If new pulmonary infiltrates were present, a bronchoscopy with BAL was performed. Only patients with abnormal CT findings, positive fungal isolates on BAL or positive GM antigen started on pre-emptive antifungal treatment and changed their anti-fungal treatment to liposomal amphotericin B or an equinocandin. Otherwise, patients remained on voriconazole prophylaxis despite continuing fever. The cumulative incidence (CI) of proven/probable IFI, pre-emptive antifungal treatment and adverse events were estimated by Kaplan-Meier survival curves.
Results
A total of 78 prophylactic voriconazole periods were analysed in a total of 44 hematologic patients. Only one patient developed a proven/probable IFI (a breakthrough candidemia) in the allogeneic stem cell transplantation group. No patient developed proven/probable IFI in the chemotherapy neither in the chronic graft versus host disease group. The cumulative incidence of pre-emptive antifungal treatment was 12.5% and 12.3% for the chemotherapy and the allogeneic stem cell transplantation respectively. The most frequent adverse event was hepatic toxicity with a cumulative incidence of 10.7%, 25.8% and 27.3% in the chemotherapy, the allogeneic stem cell transplantation and the chronic graft versus host disease respectively. No hepatic failure was registered and hepatic toxicity was reversible after drug discontinuation or transient interruption.
Conclusion
Voriconazole is a safe and an effective antifungal agent for prophylaxis of IFI in high-risk hematologic patients with a success rate of 97.4% provided that frequent liver monitoring and short intermittent interruptions are performed. Voriconazole prophylaxis allows for strategies with no empirical use of systemic anti-fungals.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Allogeneic stem cell transplant, Anti-fungal prophylaxis, Chronic graft-versus-host
Type: Eposter Presentation
Background
Invasive fungal infections (IFI), predominantly aspergillosis and candidiasis, remain an important cause of morbidity and mortality following high-dose chemotherapy and allogeneic stem cell transplantation (alloSCT).
Aims
The primary endpoint of this study was to analysed the efficacy and safety of voriconazole primary antifungal prophylaxis in combination with a pre-emptive antifungal strategy in high-risk hematologic patients.
Methods
This is a retrospective, observational and non-interventional study conducted from March 2009 until February 2012 at the Complejo Hospitalario de Navarra. Patients could receive voriconazole prophylaxis at different periods of time in the course of their disease if they were at high-risk of IFI: following intensive chemotherapy (n=24), allogeneic stem cell transplantation (n=43) or receiving high-dose corticosteroids treatment for chronic graft versus host disease (n=11). If patients developed prolonged unresponsive fever after 5 days of broad-spectrum antibacterials and/or galactomannan antigen was positive, a high-resolution computed tomography (CT) was performed. If new pulmonary infiltrates were present, a bronchoscopy with BAL was performed. Only patients with abnormal CT findings, positive fungal isolates on BAL or positive GM antigen started on pre-emptive antifungal treatment and changed their anti-fungal treatment to liposomal amphotericin B or an equinocandin. Otherwise, patients remained on voriconazole prophylaxis despite continuing fever. The cumulative incidence (CI) of proven/probable IFI, pre-emptive antifungal treatment and adverse events were estimated by Kaplan-Meier survival curves.
Results
A total of 78 prophylactic voriconazole periods were analysed in a total of 44 hematologic patients. Only one patient developed a proven/probable IFI (a breakthrough candidemia) in the allogeneic stem cell transplantation group. No patient developed proven/probable IFI in the chemotherapy neither in the chronic graft versus host disease group. The cumulative incidence of pre-emptive antifungal treatment was 12.5% and 12.3% for the chemotherapy and the allogeneic stem cell transplantation respectively. The most frequent adverse event was hepatic toxicity with a cumulative incidence of 10.7%, 25.8% and 27.3% in the chemotherapy, the allogeneic stem cell transplantation and the chronic graft versus host disease respectively. No hepatic failure was registered and hepatic toxicity was reversible after drug discontinuation or transient interruption.
Conclusion
Voriconazole is a safe and an effective antifungal agent for prophylaxis of IFI in high-risk hematologic patients with a success rate of 97.4% provided that frequent liver monitoring and short intermittent interruptions are performed. Voriconazole prophylaxis allows for strategies with no empirical use of systemic anti-fungals.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Allogeneic stem cell transplant, Anti-fungal prophylaxis, Chronic graft-versus-host
Abstract: E1182
Type: Eposter Presentation
Background
Invasive fungal infections (IFI), predominantly aspergillosis and candidiasis, remain an important cause of morbidity and mortality following high-dose chemotherapy and allogeneic stem cell transplantation (alloSCT).
Aims
The primary endpoint of this study was to analysed the efficacy and safety of voriconazole primary antifungal prophylaxis in combination with a pre-emptive antifungal strategy in high-risk hematologic patients.
Methods
This is a retrospective, observational and non-interventional study conducted from March 2009 until February 2012 at the Complejo Hospitalario de Navarra. Patients could receive voriconazole prophylaxis at different periods of time in the course of their disease if they were at high-risk of IFI: following intensive chemotherapy (n=24), allogeneic stem cell transplantation (n=43) or receiving high-dose corticosteroids treatment for chronic graft versus host disease (n=11). If patients developed prolonged unresponsive fever after 5 days of broad-spectrum antibacterials and/or galactomannan antigen was positive, a high-resolution computed tomography (CT) was performed. If new pulmonary infiltrates were present, a bronchoscopy with BAL was performed. Only patients with abnormal CT findings, positive fungal isolates on BAL or positive GM antigen started on pre-emptive antifungal treatment and changed their anti-fungal treatment to liposomal amphotericin B or an equinocandin. Otherwise, patients remained on voriconazole prophylaxis despite continuing fever. The cumulative incidence (CI) of proven/probable IFI, pre-emptive antifungal treatment and adverse events were estimated by Kaplan-Meier survival curves.
Results
A total of 78 prophylactic voriconazole periods were analysed in a total of 44 hematologic patients. Only one patient developed a proven/probable IFI (a breakthrough candidemia) in the allogeneic stem cell transplantation group. No patient developed proven/probable IFI in the chemotherapy neither in the chronic graft versus host disease group. The cumulative incidence of pre-emptive antifungal treatment was 12.5% and 12.3% for the chemotherapy and the allogeneic stem cell transplantation respectively. The most frequent adverse event was hepatic toxicity with a cumulative incidence of 10.7%, 25.8% and 27.3% in the chemotherapy, the allogeneic stem cell transplantation and the chronic graft versus host disease respectively. No hepatic failure was registered and hepatic toxicity was reversible after drug discontinuation or transient interruption.
Conclusion
Voriconazole is a safe and an effective antifungal agent for prophylaxis of IFI in high-risk hematologic patients with a success rate of 97.4% provided that frequent liver monitoring and short intermittent interruptions are performed. Voriconazole prophylaxis allows for strategies with no empirical use of systemic anti-fungals.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Allogeneic stem cell transplant, Anti-fungal prophylaxis, Chronic graft-versus-host
Type: Eposter Presentation
Background
Invasive fungal infections (IFI), predominantly aspergillosis and candidiasis, remain an important cause of morbidity and mortality following high-dose chemotherapy and allogeneic stem cell transplantation (alloSCT).
Aims
The primary endpoint of this study was to analysed the efficacy and safety of voriconazole primary antifungal prophylaxis in combination with a pre-emptive antifungal strategy in high-risk hematologic patients.
Methods
This is a retrospective, observational and non-interventional study conducted from March 2009 until February 2012 at the Complejo Hospitalario de Navarra. Patients could receive voriconazole prophylaxis at different periods of time in the course of their disease if they were at high-risk of IFI: following intensive chemotherapy (n=24), allogeneic stem cell transplantation (n=43) or receiving high-dose corticosteroids treatment for chronic graft versus host disease (n=11). If patients developed prolonged unresponsive fever after 5 days of broad-spectrum antibacterials and/or galactomannan antigen was positive, a high-resolution computed tomography (CT) was performed. If new pulmonary infiltrates were present, a bronchoscopy with BAL was performed. Only patients with abnormal CT findings, positive fungal isolates on BAL or positive GM antigen started on pre-emptive antifungal treatment and changed their anti-fungal treatment to liposomal amphotericin B or an equinocandin. Otherwise, patients remained on voriconazole prophylaxis despite continuing fever. The cumulative incidence (CI) of proven/probable IFI, pre-emptive antifungal treatment and adverse events were estimated by Kaplan-Meier survival curves.
Results
A total of 78 prophylactic voriconazole periods were analysed in a total of 44 hematologic patients. Only one patient developed a proven/probable IFI (a breakthrough candidemia) in the allogeneic stem cell transplantation group. No patient developed proven/probable IFI in the chemotherapy neither in the chronic graft versus host disease group. The cumulative incidence of pre-emptive antifungal treatment was 12.5% and 12.3% for the chemotherapy and the allogeneic stem cell transplantation respectively. The most frequent adverse event was hepatic toxicity with a cumulative incidence of 10.7%, 25.8% and 27.3% in the chemotherapy, the allogeneic stem cell transplantation and the chronic graft versus host disease respectively. No hepatic failure was registered and hepatic toxicity was reversible after drug discontinuation or transient interruption.
Conclusion
Voriconazole is a safe and an effective antifungal agent for prophylaxis of IFI in high-risk hematologic patients with a success rate of 97.4% provided that frequent liver monitoring and short intermittent interruptions are performed. Voriconazole prophylaxis allows for strategies with no empirical use of systemic anti-fungals.
Session topic: E-poster
Keyword(s): Acute myeloid leukemia, Allogeneic stem cell transplant, Anti-fungal prophylaxis, Chronic graft-versus-host
{{ help_message }}
{{filter}}