title: Prophylaxis of invasive aspergillosis with voriconazole or caspofungin during building work in patients with acute leukemia.
abstract: 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.
authors.affiliation: Department of Infectious Diseases, Toulouse University Hospital, Toulouse, France.
authors.forename: Amélie
authors.initials: A
authors.lastname: Chabrol
authors.forename: Lise
authors.initials: L
authors.lastname: Cuzin
authors.forename: Françoise
authors.initials: F
authors.lastname: Huguet
authors.forename: Muriel
authors.initials: M
authors.lastname: Alvarez
authors.forename: Xavier
authors.initials: X
authors.lastname: Verdeil
authors.forename: Marie Denise
authors.initials: MD
authors.lastname: Linas
authors.forename: Sophie
authors.initials: S
authors.lastname: Cassaing
authors.forename: Jacques
authors.initials: J
authors.lastname: Giron
authors.forename: Laurent
authors.initials: L
authors.lastname: Tetu
authors.forename: Michel
authors.initials: M
authors.lastname: Attal
authors.forename: Christian
authors.initials: C
authors.lastname: Récher
mesh_terms: 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
chemical_list: D000393:Air Pollutants; D054714:Echinocandins; D055666:Lipopeptides; D011743:Pyrimidines; D014230:Triazoles; D000077336:Caspofungin; D065819:Voriconazole