Long-Lasting Protective Effect of Posaconazole Prophylaxis in Patients with Acute Myeloid Leukemia Receiving Allogeneic Hematopoietic Stem Cell Transplantation.
Patients with acute myeloid leukemia (AML) during induction chemotherapy and those who receive allogeneic hematopoietic stem cell transplantation (HSCT) are at higher risk of invasive fungal infections (IFI). In the present study, we investigated whether the risk of IFI in AML patients receiving HSCT might be affected by the antifungal prophylaxis with posaconazole administered during the induction/salvage chemotherapy treatment. Between August 2001 and April 2015, 130 patients with AML received itraconazole/fluconazole (group A) and 99 received posaconazole (group B) as antifungal prophylaxis after induction/salvage chemotherapy at 7 Italian centers and all patients received fluconazole as antifungal prophylaxis after HSCT. The median duration of antifungal prophylaxis after induction/salvage chemotherapy was significantly longer for patients in group A than for those in group B (24 days versus 20 days, P = .019). The 1-year cumulative incidence of proven/probable IFI after HSCT was 14% and 4% in group A and group B, respectively (P = .012). Fungal-free survival and overall survival at 1 year after HSCT were 66% and 70% in group A, and 75% and 77% in group B (P = .139 and P = .302), respectively. Multivariate logistic analysis identified the use of alternative donors (matched unrelated donor: odds ratio [OR], 3.25; haploidentical/partially matched related donor: OR, 3.19), antifungal prophylaxis with itraconazole/fluconazole (OR, 3.82), and reduced-intensity conditioning (OR, 4.92) as independent risk factors for the development of IFI after HSCT. In summary, the present study suggests that the protective effects of posaconazole during induction/salvage chemotherapy for AML patients may have long-lasting benefits and eventually contribute to reduce the risk of IFI when patients undergo allogeneic HSCT.
Department of Oncology and Hematology, Stem Cell Transplant Center, AOU Citta' della Salute e della Scienza, Turin, Italy. Electronic address: abusca@cittadellasalute.to.it.
Alessandro
A
Busca
Division of Hematology and SCT Unit, University Hospital of Udine, Italy.
Anna
A
Candoni
Department of Oncology and Hematology, AOU Citta' della Salute e della Scienza, Turin, Italy.
Ernesta
E
Audisio
Division of Nuclear Medicine, AOU Citta' della Salute e della Scienza, Turin, Italy.
Roberto
R
Passera
Department of Oncology and Hematology, Stem Cell Transplant Center, AOU Citta' della Salute e della Scienza, Turin, Italy.
Benedetto
B
Bruno
SC Ematologia, ASO SS Antonio e Biagio Alessandria, Italy.
Federico
F
Monaco
Hematology, Azienda Ospedaliera S Croce e Carle, Cuneo, Italy.
Nicola
N
Mordini
Ematologia-CTMO Ospedale Roberto Binaghi Cagliari, Italy.
Adriana
A
Vacca
Sezione di Ematologia, Dipartimento dell'Emergenza e dei Trapianti d'Organo-Università di Bari, Italy.
Mario
M
Delia
Sezione di Ematologia, Università di Parma, Italy.
Franco
F
Aversa
Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma, Italy.
Livio
L
Pagano
D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D000935:Antifungal Agents / Q000627:therapeutic use; D001782:Blood Donors; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D060828:Induction Chemotherapy; D000072742:Invasive Fungal Infections / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D017964:Itraconazole / Q000627:therapeutic use; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011292:Premedication / Q000379:methods; D016879:Salvage Therapy / Q000379:methods / Q000401:mortality; D016019:Survival Analysis; D014230:Triazoles / Q000008:administration & dosage*; D055815:Young Adult
D000935:Antifungal Agents; D014230:Triazoles; D017964:Itraconazole; C101425:posaconazole; D015725:Fluconazole
Acute myeloid leukemia; Antifungal prophylaxis; Infections; Invasive fungal