Contributions
Abstract: PB1595
Type: Publication Only
Session title: Infections in hematology (incl. supportive care/therapy)
Background
Antifungal prophylaxis is routinely prescribed in patients with haematological malignancies receiving chemotherapy. Breakthrough fungal infections are still problematic in these patients and can be difficult to treat.
Aims
This review was conducted to determine the incidence of breakthrough fungal infections, and to assess the adequacy of current antifungal prophylactic practices in our Centre.
Methods
All patients admitted in the Haematology Ward at the Sir Anthony Mamo Oncology Centre (Malta) over a total of 19 months were included. Data about the underlying diagnosis and the incidence of fungal infections was obtained from medical notes.
Results
A total of 169 admitted patients with the following malignancies were admitted: 29.6% (n=50) with acute myeloid leukaemia (AML), 45% (n=76) with non-Hodgkin’s lymphoma (NHL), 5.9% (n=10) with Hodgkin’s lymphoma, 5.9% (n=10) with acute lymphoblastic leukaemia (ALL), 3% (n=5) with Burkitt’s lymphoma, and 10.6% (n=18) being a mixture of myeloma, chronic lymphocytic leukaemia (CLL) or post allogeneic transplant patients.
From these 169 patients, 56.8% (n=96) were on fluconazole, with 8.3% (n=8) developing a localized fungal infection and another 8.3% developing a systemic infection. Of the 46 patients on itraconazole, 19.6% (n=9) developed a localized fungal infection and 17.3% (n=8) developed an invasive fungal infection. Three patients were on liposomal amphotericin prophylaxis – one developed a skin infection requiring topical treatment, and two developed an invasive fungal infection requiring escalation to voriconazole. Out of nine patients on Nystatin, there was one systemic fungal infection and no localized infections– only lymphoma patients were on this prophylactic drug.
The antifungal agent with the least incidence of breakthrough infections was posaconazole. 7.1% (n=12) of patients were prescribed this drug. No breakthrough infections were reported.
AML patients predominantly received itraconazole prophylaxis (68%, n=34), as did ALL patients (60%, n=6). Burkitt’s lymphoma patients received fluconazole primarily (60%, n=3), with the one case of systemic candidaemia occurring on this drug. Fluconazole was the predominant prophylaxis in patients with NHL (78.9%, n=60), Hodgkin’s lymphoma (90%, n=9) and plasma cell disorders (100%, n=11).
Breakthrough fungal infections occurred in 24.3% of admissions (n=41); 53.6% were systemic in nature (n=22). Half of these systemic infections occurred in AML patients (n=11), with five cases of candidaemia and 6 cases of aspergillosis. ALL patients made up 13.6% of these systemic infections (n=3), with one case each of aspergillosis, candidaemia and mucormycosis. The remaining systemic infections were as follows: 31.8% in NHL (n=7) and 5% in Burkitt’s (n=1).
Conclusion
The patients at highest risk of breakthrough fungal infections are the AML group, with a significant incidence in ALL patients, despite itraconazole prophylaxis in these groups. Admitted NHL patients also had a high incidence of systemic fungal infections despite prophylaxis. Those on Nystatin did not seem to be at increased risk however; most likely these are low risk patients which did not receive intensive chemotherapy regimens. Liposomal amphotericin does not seem to provide adequate prophylaxis, as fungal infections still occurred with a 100% rate. Our analysis suggests that posaconazole is the most effective prophylactic antifungal agent prescribed locally.
Keyword(s): Anti-fungal prophylaxis, Chemotherapy, Hematological malignancy
Abstract: PB1595
Type: Publication Only
Session title: Infections in hematology (incl. supportive care/therapy)
Background
Antifungal prophylaxis is routinely prescribed in patients with haematological malignancies receiving chemotherapy. Breakthrough fungal infections are still problematic in these patients and can be difficult to treat.
Aims
This review was conducted to determine the incidence of breakthrough fungal infections, and to assess the adequacy of current antifungal prophylactic practices in our Centre.
Methods
All patients admitted in the Haematology Ward at the Sir Anthony Mamo Oncology Centre (Malta) over a total of 19 months were included. Data about the underlying diagnosis and the incidence of fungal infections was obtained from medical notes.
Results
A total of 169 admitted patients with the following malignancies were admitted: 29.6% (n=50) with acute myeloid leukaemia (AML), 45% (n=76) with non-Hodgkin’s lymphoma (NHL), 5.9% (n=10) with Hodgkin’s lymphoma, 5.9% (n=10) with acute lymphoblastic leukaemia (ALL), 3% (n=5) with Burkitt’s lymphoma, and 10.6% (n=18) being a mixture of myeloma, chronic lymphocytic leukaemia (CLL) or post allogeneic transplant patients.
From these 169 patients, 56.8% (n=96) were on fluconazole, with 8.3% (n=8) developing a localized fungal infection and another 8.3% developing a systemic infection. Of the 46 patients on itraconazole, 19.6% (n=9) developed a localized fungal infection and 17.3% (n=8) developed an invasive fungal infection. Three patients were on liposomal amphotericin prophylaxis – one developed a skin infection requiring topical treatment, and two developed an invasive fungal infection requiring escalation to voriconazole. Out of nine patients on Nystatin, there was one systemic fungal infection and no localized infections– only lymphoma patients were on this prophylactic drug.
The antifungal agent with the least incidence of breakthrough infections was posaconazole. 7.1% (n=12) of patients were prescribed this drug. No breakthrough infections were reported.
AML patients predominantly received itraconazole prophylaxis (68%, n=34), as did ALL patients (60%, n=6). Burkitt’s lymphoma patients received fluconazole primarily (60%, n=3), with the one case of systemic candidaemia occurring on this drug. Fluconazole was the predominant prophylaxis in patients with NHL (78.9%, n=60), Hodgkin’s lymphoma (90%, n=9) and plasma cell disorders (100%, n=11).
Breakthrough fungal infections occurred in 24.3% of admissions (n=41); 53.6% were systemic in nature (n=22). Half of these systemic infections occurred in AML patients (n=11), with five cases of candidaemia and 6 cases of aspergillosis. ALL patients made up 13.6% of these systemic infections (n=3), with one case each of aspergillosis, candidaemia and mucormycosis. The remaining systemic infections were as follows: 31.8% in NHL (n=7) and 5% in Burkitt’s (n=1).
Conclusion
The patients at highest risk of breakthrough fungal infections are the AML group, with a significant incidence in ALL patients, despite itraconazole prophylaxis in these groups. Admitted NHL patients also had a high incidence of systemic fungal infections despite prophylaxis. Those on Nystatin did not seem to be at increased risk however; most likely these are low risk patients which did not receive intensive chemotherapy regimens. Liposomal amphotericin does not seem to provide adequate prophylaxis, as fungal infections still occurred with a 100% rate. Our analysis suggests that posaconazole is the most effective prophylactic antifungal agent prescribed locally.
Keyword(s): Anti-fungal prophylaxis, Chemotherapy, Hematological malignancy