title: Primary antifungal prophylaxis in adult patients with acute lymphoblastic leukaemia: a multicentre audit.
abstract: OBJECTIVE
  The primary objectives were to investigate the prescribing practices of primary antifungal prophylaxis (PAP) and incidence of invasive fungal disease (IFD) in adult patients with ALL receiving induction-consolidation chemotherapy. Secondary objectives were to determine risk factors for IFD and resource utilization associated with IFD.
  
  
  METHODS
  A retrospective chart review of adult patients with ALL from commencement of induction until completion of consolidation chemotherapy was undertaken from January 2008 to June 2013 in four hospitals in Melbourne, Australia. IFD was classified according to the revised European Organisation for Research and Treatment of Cancer criteria. Cost analysis was performed from an Australian public hospital perspective.
  
  
  RESULTS
  Ninety-eight patients were included in the audit; 83 (85%) received PAP. Most patients (49/83, 59%) switched between two different antifungal agents, predominantly between liposomal amphotericin B and an azole. Five proven/probable and six possible IFD cases were identified. Proven/probable IFD was most common in patients receiving the BFM95 chemotherapy protocol. The incidence of proven/probable IFD was significantly lower in patients receiving PAP compared with those who did not (2/78, 2.6% versus 3/14, 21.4%; P = 0.024). For every five patients receiving PAP, one proven/probable IFD case would be prevented. Proven/probable IFD was associated with an additional median cost of 121,520 Australian dollars (95% CI: 90,781-180,141 Australian dollars; P < 0.001) compared with patients without IFD.
  
  
  CONCLUSIONS
  This is the first multicentre study evaluating PAP use in patients with ALL. With the caveats of interpretation of retrospective, non-randomized data, PAP was associated with a reduced IFD risk.
authors.affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.
authors.forename: Tan N
authors.initials: TN
authors.lastname: Doan
authors.affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia.
authors.forename: Carl M J
authors.initials: CM
authors.lastname: Kirkpatrick
authors.affiliation: Malignant Haematology and Stem Cell Transplantation Service, Alfred Health, Melbourne, Victoria, Australia.
authors.forename: Patricia
authors.initials: P
authors.lastname: Walker
authors.affiliation: Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Monica A
authors.initials: MA
authors.lastname: Slavin
authors.affiliation: General Medicine Unit, Alfred Health, Melbourne, Victoria, Australia Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia.
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Ananda-Rajah
authors.affiliation: Malignant Haematology and Stem Cell Transplantation Service, Alfred Health, Melbourne, Victoria, Australia Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia Department of Haematology, Monash University, Melbourne, Victoria, Australia.
authors.forename: C Orla
authors.initials: CO
authors.lastname: Morrissey
authors.affiliation: Pharmacy Department, Austin Health, Melbourne, Victoria, Australia Infectious Diseases Department, Austin Health, Melbourne, Victoria, Australia.
authors.forename: Karen F
authors.initials: KF
authors.lastname: Urbancic
authors.affiliation: University of Melbourne, Melbourne, Victoria, Australia Department of Clinical Haematology, Austin Health, Melbourne, Victoria, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Grigg
authors.affiliation: Malignant Haematology and Stem Cell Transplantation Service, Alfred Health, Melbourne, Victoria, Australia Department of Haematology, Monash University, Melbourne, Victoria, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Spencer
authors.affiliation: University of Melbourne, Melbourne, Victoria, Australia Department of Clinical Haematology and Bone Marrow Transplant Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Szer
authors.affiliation: University of Melbourne, Melbourne, Victoria, Australia Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: John F
authors.initials: JF
authors.lastname: Seymour
authors.affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia david.kong@monash.edu.
authors.forename: David C M
authors.initials: DC
authors.lastname: Kong
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000191:economics / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D018890:Chemoprevention / Q000191:economics / Q000379:methods*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology* / Q000517:prevention & control*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents