title: Voriconazole is a safe and effective anti-fungal prophylactic agent during induction therapy of acute myeloid leukemia.
abstract: BACKGROUND
  Antifungal prophylaxis (AFP) reduces the incidence of invasive fungal infections (IFIs) during induction therapy of acute myeloid leukemia (AML). Posaconazole is considered the standard of care. Voriconazole, a generic cheaper alternative is a newer generation azole with broad anti-fungal activity. There is limited data on the use of voriconazole as a prophylactic drug.
  
  
  METHODS
  A single-center, prospective study was performed during which patients with AML undergoing induction chemotherapy received voriconazole as AFP (April 2012 to February 2014). Outcomes were compared with historical patients who received fluconazole as AFP (January 2011-March 2012, n = 66).
  
  
  RESULTS
  Seventy-five patients with AML (median age: 17 years [range: 1-75]; male:female 1.6:1) received voriconazole as AFP. The incidence of proven/probable/possible (ppp) IFI was 6.6% (5/75). Voriconazole and fluconazole cohorts were well-matched with respect to baseline characteristics. Voriconazole (when compared to fluconazole) reduced the incidence of pppIFI (5/75, 6.6% vs. 19/66, 29%; P < 0.001), need to start therapeutic (empiric + pppIFI) antifungals (26/75, 34% vs. 51/66, 48%; P < 0.001) and delayed the start of therapeutic antifungals in those who needed it (day 16 vs. day 10; P < 0.001). Mortality due to IFI was also reduced with the use of voriconazole (1/75, 1.3% vs. 6/66, 9%; P = 0.0507), but this was not significant. Three patients discontinued voriconazole due to side-effects.
  
  
  CONCLUSIONS
  Voriconazole is an effective and safe oral agent for IFI prophylaxis during induction therapy of AML. Availability of generic equivalents makes this a more economical alternative to posaconazole.
authors.affiliation: Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India.
authors.forename: Akash
authors.initials: A
authors.lastname: Shah
authors.affiliation: Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India.
authors.forename: Prasanth
authors.initials: P
authors.lastname: Ganesan
authors.affiliation: Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India.
authors.forename: Venkatraman
authors.initials: V
authors.lastname: Radhakrishnan
authors.affiliation: Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India.
authors.forename: Krishnarathinam
authors.initials: K
authors.lastname: Kannan
authors.affiliation: Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India.
authors.forename: Rejiv
authors.initials: R
authors.lastname: Rajendranath
authors.affiliation: Department of Radiodiagnosis, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India.
authors.forename: Vandana
authors.initials: V
authors.lastname: Mahajan
authors.affiliation: Department of Microbiology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India.
authors.forename: Varalakshmi
authors.initials: V
authors.lastname: Vijayakumar
authors.affiliation: Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India.
authors.forename: Trivadi
authors.initials: T
authors.lastname: Ganesan
authors.affiliation: Department of Medical Oncology, Cancer Institute (WIA), Adyar, Chennai, Tamil Nadu, India.
authors.forename: Tenali Gnana
authors.initials: TG
authors.lastname: Sagar
keywords: Acute myeloid leukemia; anti-fungal prophylaxis; fluconazole; invasive fungal infection; voriconazole