title: Effectiveness of primary anti-Aspergillus prophylaxis during remission induction chemotherapy of acute myeloid leukemia.
abstract: Although antifungal prophylaxis is frequently administered to patients with acute myeloid leukemia (AML) during remission-induction chemotherapy (RIC), its impact on reducing invasive fungal infections (IFIs) outside clinical trials is rarely reported. We performed a retrospective observational study to identify risk factors for development of IFIs (definite or probable, using revised European Organization for Research and Treatment of Cancer [EORTC] criteria) and all-cause mortality in a cohort of 152 AML patients receiving RIC (2009 to 2011). We also compared rates of IFI and mortality in patients who received echinocandin versus anti-Aspergillus azole (voriconazole or posaconazole) prophylaxis during the first 120 days of RIC. In multivariate analysis, clofarabine-based RIC (hazard ratio [HR], 3.5; 95% confidence interval [CI], 1.5 to 8.3; P = 0.004) and echinocandin prophylaxis (HR, 4.6; 95% CI, 1.8 to 11.9; P = 0.002) were independently associated with higher rates of IFI rates during RIC. Subsequent analysis failed to identify any malignancy- or chemotherapy-related covariates linked to echinocandin prophylaxis that accounted for the higher rates of breakthrough IFI. Although the possibility of other confounding variables cannot be excluded, our findings suggest that echinocandin-based prophylaxis during RIC for AML may be associated with a higher risk of breakthrough IFI.
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Texas, USA.
authors.forename: Marisa Z R
authors.initials: MZ
authors.lastname: Gomes
authors.forename: Ying
authors.initials: Y
authors.lastname: Jiang
authors.forename: Victor E
authors.initials: VE
authors.lastname: Mulanovich
authors.forename: Russell E
authors.initials: RE
authors.lastname: Lewis
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D001230:Aspergillus / Q000187:drug effects*; D054714:Echinocandins / Q000627:therapeutic use; D005260:Female; D006801:Humans; D060828:Induction Chemotherapy / Q000379:methods*; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D014230:Triazoles; C101425:posaconazole; D065819:Voriconazole