Mixed treatment comparison of randomised clinical trials of primary antifungal prophylaxis in allogeneic haematopoietic stem cell transplant recipients – focus on invasive aspergillosis

Ref ID: 17772

Author:

E.J. Bow*, D.J. Vanness, C. Cordonnier, O.A. Cornely, D.I. Marks,
A. Pagliuca, M. Slavin, C. Solano, A. Shaul, S. Sorensen, L. Cragin,
R. Chambers, M. Kantecki, D. Weinstein, H. Schlamm

Author address:

(Winnipeg, CA;
Madison, US; Creteil, FR; Cologne, DE; Bristol, London, UK;
Melbourne, AU; Valencia, ES; Manitowoc, Bethesda, Collegeville, US;
Paris, FR; New York, US)

Full conference title:

22nd European Congress of Clinical Microbiology and Infectious Diseases

Abstract:

Objectives: Invasive aspergillosis (IA) is the most frequent invasive
fungal infection (IFI) in allogeneic haematopoietic stem cell transplant
(alloHCT) recipients post-engraftment and is associated with high
mortality. The oral azoles fluconazole (FLU), itraconazole (ITR),
posaconazole (POS), and voriconazole (VOR) can potentially prevent
IFI in this setting. The optimum choice for primary prophylaxis of IA in
alloHCT is unknown, since these agents have not been directlyefficacy of prophylaxis with posaconazole (POS) when compared to old
azoles in a ’’real life’’ setting.
Methods: From January 2010 to March 2011, all newly diagnosed
AMLs have been consecutively registered and prospectively monitored
in 31 Italian participating centers. Only adult cases that received
conventional chemotherapy were included in the present study.
Principal demographic and clinical data, as well as antifungal
treatments were collected. In particular we analyzed data about
systemic AF prophylaxis: the drug of choice, the duration of
treatment, and its efficacy were thus evaluated. To determine
prophylaxis efficacy, incidence of proven/probable IFDs was assessed
at 30th day from the end of chemotherapy.
Results: Four hundred and nintey-eight AML were evaluated in the
present analysis. The most part of them (448, 90%) received systemic
antifungal prophylaxis. POS was the most frequently employed drug
(224/448, 50%), followed by fluconazole (128, 29%) and itraconazole
(86, 19%). When comparing the POS group (224 pts) to those receiving
itraconazole or fluconazole (214 pts) (FLU/ITRA) no significant
differences emerged in terms of the main risk factors for IFDs (table).
In particular the two groups resulted to be comparable in terms of age,
sex, frequency and duration of deep neutropenia, days of prophylaxis.
On the contrary, there were significant differences in breakthrough IFDs
(6.2% in POS vs 11.7% in FLU/ITRA, p-value 0.04). Except for one
case of fusariosis, all mold infections were invasive aspergillosis. Yeast
infections also were more frequent in the FLU/ITRA group.
Caspofungin and amphotericin B compounds were the most
frequently employed drugs, as empirical/pre-emptive treatments.
There were no significant differences in the response rate, nor in the
IFDs attributable mortality rate.

Abstract Number: P867

Conference Poster: y

Conference Year: 2012

Link to conference website: NULL

New link: NULL

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