title: Evaluation of the practice of antifungal prophylaxis use in patients with newly diagnosed acute myeloid leukemia: results from the SEIFEM 2010-B registry.
abstract: BACKGROUND
  To analyze the efficacy of antifungal prophylaxis (AFP) with posaconazole and itraconazole in a real-life setting of patients with acute myeloid leukemia (AML) during the first induction of remission.
  
  
  METHODS
  From January 2010 to June 2011, all patients with newly diagnosed AML were consecutively registered and prospectively monitored at 30 Italian hematological centers. Our analysis focused on adult patients who received intensive chemotherapy and a mold-active AFP for at least 5 days. To determine the efficacy of prophylaxis, invasive fungal disease (IFD) incidence, IFD-attributable mortality, and overall survival were evaluated.
  
  
  RESULTS
  In total, 515 patients were included in the present analysis. Posaconazole was the most frequently prescribed drug (260 patients [50%]) followed by fluconazole (148 [29%]) and itraconazole (93 [18%]). When comparing the groups taking posaconazole and itraconazole, there were no significant differences in the baseline clinical characteristics, whereas there were significant differences in the percentage of breakthrough IFDs (18.9% with posaconazole and 38.7% with itraconazole, P< .001). The same trend was observed when only proven/probable mold infections were considered (posaconazole, 2.7% vs itraconazole, 10.7%, P= .02). There were no significant differences in the IFD-associated mortality rate, while posaconazole prophylaxis had a significant impact on overall survival at day 90 (P= .002).
  
  
  CONCLUSIONS
  During the last years, the use of posaconazole prophylaxis in high-risk patients has significantly increased. Although our study was not randomized, it demonstrates in a real-life setting that posaconazole prophylaxis confers an advantage in terms of both breakthrough IFDs and overall survival compared to itraconazole prophylaxis.
  
  
  BACKGROUND
  NCT01315925.
authors.affiliation: Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma, Italy. lpagano@rm.unicatt.it
authors.forename: Livio
authors.initials: L
authors.lastname: Pagano
authors.forename: Morena
authors.initials: M
authors.lastname: Caira
authors.forename: Anna
authors.initials: A
authors.lastname: Candoni
authors.forename: Franco
authors.initials: F
authors.lastname: Aversa
authors.forename: Carlo
authors.initials: C
authors.lastname: Castagnola
authors.forename: Cecilia
authors.initials: C
authors.lastname: Caramatti
authors.forename: Chiara
authors.initials: C
authors.lastname: Cattaneo
authors.forename: Mario
authors.initials: M
authors.lastname: Delia
authors.forename: Maria Rosaria
authors.initials: MR
authors.lastname: De Paolis
authors.forename: Roberta
authors.initials: R
authors.lastname: Di Blasi
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Caprio
authors.forename: Rosa
authors.initials: R
authors.lastname: Fanci
authors.forename: Mariagrazia
authors.initials: M
authors.lastname: Garzia
authors.forename: Bruno
authors.initials: B
authors.lastname: Martino
authors.forename: Lorella
authors.initials: L
authors.lastname: Melillo
authors.forename: Maria Enza
authors.initials: ME
authors.lastname: Mitra
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Nadali
authors.forename: Annamaria
authors.initials: A
authors.lastname: Nosari
authors.forename: Marco
authors.initials: M
authors.lastname: Picardi
authors.forename: Leonardo
authors.initials: L
authors.lastname: Potenza
authors.forename: Prassede
authors.initials: P
authors.lastname: Salutari
authors.forename: Enrico Maria
authors.initials: EM
authors.lastname: Trecarichi
authors.forename: Mario
authors.initials: M
authors.lastname: Tumbarello
authors.forename: Luisa
authors.initials: L
authors.lastname: Verga
authors.forename: Nicola
authors.initials: N
authors.lastname: Vianelli
authors.forename: Alessandro
authors.initials: A
authors.lastname: Busca
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use*; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications / Q000517:prevention & control*; D014230:Triazoles / Q000627:therapeutic use*
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; D017964:Itraconazole; C101425:posaconazole