Posaconazole prophylaxis in acute myeloid leukemia. Real life experience in four hematological centers

Ref ID: 19437

Author:

A. Candoni,1 E. Simeone,1 M. Caira,2 M. Delia,3 L. Castagna,4
L. Potenza,5 L. Pagano,2 G. Specchia,3 M. Luppi5 and R. Fanin1

Author address:

1Division of Hematology and BMT, Udine, Italy; 2Institute of
Hematology, Universit a Cattolica S. Cuore., Rome, Italy;
3Hematology Section, University of Bari., Italy; 4Humanitas
Cancer Center, ROZZANO, Milano., Italy and 5Division of
Hematology,

Full conference title:

6th Trends in Medical Mycology 2013

Date: 11 October 2014

Abstract:

Introduction Acute Myeloid Leukemia (AML) patients (pts) are at
high risk of Invasive Fungal Diseases (IFD). Posaconazole (POS), an
oral azole with a broader spectrum, was approved for the prophylaxis
of IFD in high risk hematologic pts. We report a multicenter real-life
experience with POS prophylaxis in AML. We also compare the per-
formance of POS with an historical, well matched, control group of
AML pts who received prophylaxis with Fluconazole (FLUCO) or Itr-
aconazole (ITRA).
Patients and Results 120 unselected and consecutive AML pts (96
with active disease and 24 in CR) received POS prophylaxis (600 mg
daily), between Jan 2009 and Dec 2012, in 4 Hematological Centers.
Median age was 52 yrs (range 18-69). All cases were given inten-
sive chemotherapy. The POS was started when neutrophil (PMN)
count was less than 1000 mL and was stopped at PMN recovery.
The median duration of severe neutropenia (PMN lower than
500 mL) was 16 days (range 7-71); 27/120 (23%) of cases had an
oral mucositis grade II-III CTC and 74% of these pts received a pro-
ton pump inhibitor. An active diagnostic work up was made in all
cases with GM assay, standard chest X-ray and thoracic CT scan in
case of FUO lasting over 48 hours. The median duration of POS was
16 days (range 7-41). Only 17/120 (14%) of pts required parenteral
empiric or pre-emptive antimycotic therapy and only 6/120 (5%)
experienced a probable or proven IFD. Mortality IFD related was 0%.
POS was well tolerated and only 8% of pts experienced mild drug
related side effects. No cases of POS discontinuation were reported.
When we compare the 120 pts who received POS with an historical
control group of 120 AML pts who received FLUCO or ITRA prophy-
laxis, no significant differences were observed for underling disease
status, age, IFD risk factors, days of severe neutropenia and days of
prophylaxis. Instead, there were significant differences in number of
cases who required parenteral antymicotic therapy (14% in POS
group vs 25% in the control group; P = 0.01), and in days of paren-
teral antymicotic therapy (151 vs 374, with a saving of 223 days).
Conclusions This real-life experience confirms that POS prophylaxis
is safe, well tolerated and effective in unselected AML pts. Only 14%
of these high risk pts required parenteral antimycotic therapy and
only 6/120(5%) experienced probable (5/120) or proven (1/120)
IFD. We also confirm that POS, in real life setting, is more effective
than FLUCO/ITRA as antifungal prophylaxis in AML pts.

Abstract Number: p321

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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