Prophylaxis of invasive aspergillosis with voriconazole or caspofungin during building work in patients with acute leukemia.
BACKGROUND
Invasive aspergillosis is a common life-threatening infection in patients with acute leukemia. The presence of building work near to hospital wards in which these patients are cared for is an important risk factor for the development of invasive aspergillosis. This study assessed the impact of voriconazole or caspofungin prophylaxis in patients undergoing induction chemotherapy for acute leukemia in a hematology unit exposed to building work.


METHODS
This retrospective cohort study was carried out between June 2003 and January 2006 during which building work exposed patients to a persistently increased risk of invasive aspergillosis. This study compared the cumulative incidence of invasive aspergillosis in patients who did or did not receive primary antifungal prophylaxis. The diagnosis of invasive aspergillosis was based on the European Organization for Research and Treatment of Cancer/Mycosis Study Group criteria.


RESULTS
Two-hundred and fifty-seven patients (213 with acute myeloid leukemia, 44 with acute lymphocytic leukemia) were included. The mean age of the patients was 54 years and the mean duration of their neutropenia was 21 days. Eighty-eight received antifungal prophylaxis, most with voriconazole (n=74). The characteristics of the patients who did or did not receive prophylaxis were similar except that pulmonary antecedents (chronic bronchopulmonary disorders or active tobacco use) were more frequent in the prophylaxis group. Invasive aspergillosis was diagnosed in 21 patients (12%) in the non-prophylaxis group and four (4.5%) in the prophylaxis group (P=0.04). Pulmonary antecedents, neutropenia at diagnosis and acute myeloid leukemia with high-risk cytogenetics were positively correlated with invasive aspergillosis, whereas primary prophylaxis was negatively correlated. Survival was similar in both groups. No case of zygomycosis was observed. The 3-month mortality rate was 28% in patients with invasive aspergillosis.


CONCLUSIONS
This study suggests that antifungal prophylaxis with voriconazole could be useful in acute leukemia patients undergoing first remission-induction chemotherapy in settings in which there is a high-risk of invasive aspergillosis.
Chabrol
Amélie
A
Department of Infectious Diseases, Toulouse University Hospital, Toulouse, France.
Cuzin
Lise
L
Huguet
Françoise
F
Alvarez
Muriel
M
Verdeil
Xavier
X
Linas
Marie Denise
MD
Cassaing
Sophie
S
Giron
Jacques
J
Tetu
Laurent
L
Attal
Michel
M
Récher
Christian
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D000393:Air Pollutants / Q000009:adverse effects*; D000077336:Caspofungin; D015331:Cohort Studies; D003252:Construction Materials / Q000009:adverse effects*; D054714:Echinocandins / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host / Q000187:drug effects / Q000276:immunology; D055744:Invasive Pulmonary Aspergillosis / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D055666:Lipopeptides; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D011743:Pyrimidines / Q000008:administration & dosage*; D012189:Retrospective Studies; D014230:Triazoles / Q000008:administration & dosage*; D065819:Voriconazole; D055815:Young Adult
D000393:Air Pollutants; D054714:Echinocandins; D055666:Lipopeptides; D011743:Pyrimidines; D014230:Triazoles; D000077336:Caspofungin; D065819:Voriconazole