Contributions
Abstract: PB2043
Type: Publication Only
Background
Immunocompromised patients (pts) are at high risk of invasive fungal infections (IFIs), in particular those affected by acute myeloid leukemia (AML) undergoing remission-induction chemotherapy. Posaconazole (PSZ) is now available in different formulations and its use as antifungal prophylaxis in this high-risk hematological pts is strongly recommended.
Aims
Our aim was to describe the efficacy of primary prophylaxis of IFIs with PSZ in a real-life cohort of AML pts during induction chemotherapy.
Methods
AML pts consecutively treated with remission-induction chemotherapy (up to 3rd line treatment) between January 2010 and July 2017 were selected from institutional database. We excluded acute promyelocytic leukemia, re-induction therapy performed for relapse after transplantation and patients treated with hypomethylating agent. Diagnosis of IFIs was carried out according to the revised European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) definitions published in 2008.
Results
We identified 123 AML pts who received 171 remission-induction treatments. Primary prophylaxis of IFIs with PSZ was made in 110 cases, while the remaining 61 cases did not received any systemic antifungal prophylaxis. Among patients who received PSZ, median age was 61 years (male/female ratio 64/34%), in the remaining population median age was 64 years (male/female ratio 49/51%). Seventy cases were first-line induction therapies, while 40 were re-induction treatments. PSZ was given as oral suspension in 104 cases; the tablet formulation has been introduced since 2017 and it was used in 6 cases.
Over 90% of analysed cases developed a febrile event. An antifungal treatment was administered in 28 of 61 cases (46%) which did not received prophylaxis and in 26 (23%) cases which received PSZ (p=0.003). Thirty-five (57%) cases in no prophylaxis group and 45 (41%) among PSZ group underwent a chest CT scan (p=0.039). CT alterations suggestive for IFIs were found in 71% of no PSZ cases and in 42% of PSZ cases with a statistically significant difference (p <0,01). Serum galactomannan antigen was positive in 3% of the tested cases: 1 of 106 PSZ tested cases and 4 out of 58 no PSZ tested cases (p <0,01). Yeasts and moulds were identified respectively in 5 (8%) of patients who didn’t received an antifungal prophylaxis; all microorganisms were isolated from the respiratory tract, except for one liver mould and one yeast positivity on rectal swab. Seven (6%) PSZ patients had a positivity for yeasts, in the same group 3 (3%) patients were positive for moulds (p=0.04). The latter were isolated from the respiratory tract, while almost the whole yeasts from blood samples. Seven (4%) cases were classified as proven (2 no PSZ group, 5 PSZ group), 12 (7%) as probable (9 no PSZ group, 3 PSZ group) and 24 (15 no PSZ group, 9 PSZ group) as possible IFIs. Eleven (6%) cases could not be classified (2 no PSZ, 9 PSZ). The total number of death was 14 (8%). Among patients who received an antifungal treatment, 9 deaths were observed (3 PSZ group, 6 no PSZ group). In the prophylaxed group, the most used antifungal treatment was liposomal amphotericin B (77%), followed by voriconazole (15%); while among no PSZ cases voriconazole was used in about 50% of patients (p<0.001). Twenty-one cases received a sequential or a combination regimen.
Conclusion
This monocentric survey underlined the feasibility and efficacy of PSZ prophylaxis in clinical practice; PSZ use confirm to be associated to lower incidence of IFIs, less need for antifungal treatment and lower IFIs attributable mortality.
Session topic: 31. Infectious diseases, supportive care
Keyword(s): Acute Myeloid Leukemia, Fungal infection, Prophylaxis
Abstract: PB2043
Type: Publication Only
Background
Immunocompromised patients (pts) are at high risk of invasive fungal infections (IFIs), in particular those affected by acute myeloid leukemia (AML) undergoing remission-induction chemotherapy. Posaconazole (PSZ) is now available in different formulations and its use as antifungal prophylaxis in this high-risk hematological pts is strongly recommended.
Aims
Our aim was to describe the efficacy of primary prophylaxis of IFIs with PSZ in a real-life cohort of AML pts during induction chemotherapy.
Methods
AML pts consecutively treated with remission-induction chemotherapy (up to 3rd line treatment) between January 2010 and July 2017 were selected from institutional database. We excluded acute promyelocytic leukemia, re-induction therapy performed for relapse after transplantation and patients treated with hypomethylating agent. Diagnosis of IFIs was carried out according to the revised European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) definitions published in 2008.
Results
We identified 123 AML pts who received 171 remission-induction treatments. Primary prophylaxis of IFIs with PSZ was made in 110 cases, while the remaining 61 cases did not received any systemic antifungal prophylaxis. Among patients who received PSZ, median age was 61 years (male/female ratio 64/34%), in the remaining population median age was 64 years (male/female ratio 49/51%). Seventy cases were first-line induction therapies, while 40 were re-induction treatments. PSZ was given as oral suspension in 104 cases; the tablet formulation has been introduced since 2017 and it was used in 6 cases.
Over 90% of analysed cases developed a febrile event. An antifungal treatment was administered in 28 of 61 cases (46%) which did not received prophylaxis and in 26 (23%) cases which received PSZ (p=0.003). Thirty-five (57%) cases in no prophylaxis group and 45 (41%) among PSZ group underwent a chest CT scan (p=0.039). CT alterations suggestive for IFIs were found in 71% of no PSZ cases and in 42% of PSZ cases with a statistically significant difference (p <0,01). Serum galactomannan antigen was positive in 3% of the tested cases: 1 of 106 PSZ tested cases and 4 out of 58 no PSZ tested cases (p <0,01). Yeasts and moulds were identified respectively in 5 (8%) of patients who didn’t received an antifungal prophylaxis; all microorganisms were isolated from the respiratory tract, except for one liver mould and one yeast positivity on rectal swab. Seven (6%) PSZ patients had a positivity for yeasts, in the same group 3 (3%) patients were positive for moulds (p=0.04). The latter were isolated from the respiratory tract, while almost the whole yeasts from blood samples. Seven (4%) cases were classified as proven (2 no PSZ group, 5 PSZ group), 12 (7%) as probable (9 no PSZ group, 3 PSZ group) and 24 (15 no PSZ group, 9 PSZ group) as possible IFIs. Eleven (6%) cases could not be classified (2 no PSZ, 9 PSZ). The total number of death was 14 (8%). Among patients who received an antifungal treatment, 9 deaths were observed (3 PSZ group, 6 no PSZ group). In the prophylaxed group, the most used antifungal treatment was liposomal amphotericin B (77%), followed by voriconazole (15%); while among no PSZ cases voriconazole was used in about 50% of patients (p<0.001). Twenty-one cases received a sequential or a combination regimen.
Conclusion
This monocentric survey underlined the feasibility and efficacy of PSZ prophylaxis in clinical practice; PSZ use confirm to be associated to lower incidence of IFIs, less need for antifungal treatment and lower IFIs attributable mortality.
Session topic: 31. Infectious diseases, supportive care
Keyword(s): Acute Myeloid Leukemia, Fungal infection, Prophylaxis