title: Systemic antifungal treatment after posaconazole prophylaxis: results from the SEIFEM 2010-C survey.
abstract: OBJECTIVE
  To investigate the incidence, treatment and outcome of breakthrough invasive fungal infections (IFIs) in adult acute myeloid leukaemia (AML) patients after posaconazole prophylaxis.
  
  
  METHODS
  From January 2010 to April 2012, all consecutive patients with newly diagnosed AML were prospectively registered at 33 participating Italian centres. All cases of IFIs occurring within 30 days after the end of the first induction chemotherapy were recorded. The strategy of antifungal treatment (empirical, pre-emptive or targeted) and the drugs used were analysed. ClinicalTrials.gov code: NCT01315925.
  
  
  RESULTS
  In total, 1192 patients with newly diagnosed AML were enrolled in the study, of whom 510 received posaconazole prophylaxis and were included in the present analysis. Of these patients, 140 (27%) needed systemic antifungal treatment. Among the 127 evaluable cases, an empirical approach was utilized in 102 patients (80%), a pre-emptive approach in 19 patients (15%) and targeted therapy in 6 patients (5%). Only five patients died of IFIs (three in the empirical group and two in the targeted group; 4%). A critical review of IFI diagnoses at 30 days demonstrated that among the patients treated empirically, ∼30% were not affected by IFIs but rather only by fever of unidentified origin. A comparison between the empirical and the pre-emptive groups showed no significant differences regarding the attributable and overall mortalities.
  
  
  CONCLUSIONS
  This study confirms that posaconazole prophylaxis reduces the incidence of breakthrough IFIs and does not modify the efficacy of subsequent systemic antifungal treatment, regardless of the approach (empirical or pre-emptive) or the antifungal drug used.
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.affiliation: Unità di Ematologia, Università di Milano-Bicocca, Ospedale S.Gerardo, Monza, Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Verga
authors.affiliation: Dipartimento di Ematologia, Ospedale S.Giovanni Battista, Torino, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Busca
authors.affiliation: Divisione di Ematologia, Azienda Ospedaliera 'Bianchi Melacrino Morelli', Reggio Calabria, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Martino
authors.affiliation: Divisione di Ematologia e TMO, Policlinico di Palermo, Italy.
authors.forename: Maria Enza
authors.initials: ME
authors.lastname: Mitra
authors.affiliation: Unità Operativa di Ematologia, Università di Firenze, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Fanci
authors.affiliation: Istituto di Ematologia, Università di Perugia, Italy.
authors.forename: Stelvio
authors.initials: S
authors.lastname: Ballanti
authors.affiliation: Divisione di Ematologia, Dipartimento di Medicina Clinica e Chirurgia, Università Federico II, Napoli, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Picardi
authors.affiliation: Dipartimento Onco-Ematologico, Fondazione ICRRS Policlinico San Matteo, Pavia, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Castagnola
authors.affiliation: Divisione di Ematologia, Spedali Civili di Brescia, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Cattaneo
authors.affiliation: UOC Ematologia, Azienda Ospedaliera Universitaria Integrata di Verona, Italy.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Nadali
authors.affiliation: Divisione di Ematologia e Centro Trapianti Midollo, Ospedale Niguarda Ca' Granda, Milano, Italy.
authors.forename: Annamaria
authors.initials: A
authors.lastname: Nosari
authors.affiliation: Clinica di Ematologia, Università di Udine, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Candoni
authors.affiliation: Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma, Italy.
authors.forename: Morena
authors.initials: M
authors.lastname: Caira
authors.affiliation: Dipartimento di Ematologia Clinica, Ospedale Santo Spirito, Pescara, Italy.
authors.forename: Prassede
authors.initials: P
authors.lastname: Salutari
authors.affiliation: Ematologia ed Immunologia Clinica, Dipartimento di Medicina, Università di Padova, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Lessi
authors.affiliation: Istituto di Ematologia, Università di Parma, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Aversa
authors.affiliation: Istituto di Malattie Infettive, Università Cattolica del Sacro Cuore, Roma, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Tumbarello
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000008:administration & dosage*; D003625:Data Collection / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; C101425:posaconazole
keywords: acute myeloid leukaemia; antifungal prophylaxis; empirical therapy