Effectiveness of Primary anti-Aspergillus Prophylaxis During Remission Induction Chemotherapy of Acute Myeloid Leukemia.
Antimicrob Agents Chemother. 2014 Mar 3;
Authors: Gomes MZ, Jiang Y, Mulanovich VE, Lewis RE, Kontoyiannis DP
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 of clinical trials is rarely reported. We performed a retrospective observational study to identify risk factors for development of IFIs (definite or probable, revised EORTC criteria) and all-cause mortality in a cohort of 152 AML patients receiving RIC (2009-2011). We also compared IFI rates and mortality in patients who received echinocandin vs. anti-Aspergillus azole (voriconazole or posaconazole) prophylaxis during the first 120 days of RIC. In multivariate analysis, clofarabine-based RIC (HR 3.5, 95% CI 1.5-8.3; P=0.004) and echinocandin prophylaxis (HR 4.6, 95% CI 1.8-11.9; 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 higher risk of breakthrough IFI.
PMID: 24590477 [PubMed - as supplied by publisher]