10 Years of Azole Prophylaxis in Acute Myeloid Leukemia (AML) Patients: A Retrospective Study of Fluconazole, Itraconazole, Voriconazole and Posaconazole in at an Australian Tertiary Center

M. R. ANANDA-RAJAH, M. T. DOWNEY, A. BAJEL, K. T. THURSKY, A. P. GRIGG, M. A. SLAVIN;

Author address: 

The Royal Melbourne Hosp., Melbourne, Australia.

Abstract: 

Background: Antifungal prophylaxis remains an important strategy in the prevention of invasive fungal infections (IFIs) in high-risk haematology patients. The relative efficacies of azole prophylaxis in AML patients undergoing arabinoside/anthracycline based chemotherapy was evaluated. Methods: In this retrospective chart review from 1999-2009, 242 consecutive patients received 491 courses of prophylaxis including fluconazole (1999-2000), itraconazole solution (2001-2002), voriconazole (2003-2006) and posaconazole (2006-2009) at standard doses. Antifungals were instituted at or before chemotherapy commencement until neutrophil recovery i.e. ≥ 0.5 x 109/L defining a course. Probable/proven IFI was reported and attributed to the predominant prophylactic agent received at the time of diagnosis. Conclusion: A shift towards prophylaxis with azoles with potent anti- mold activity has seen a decline in IFI incidence among AML patients undergoing intensive chemotherapy. Non-aspergillus mold infections have become more frequent while candida remains uncommon. The cost-effectiveness of this strategy however, remains unknown, highlighting the need for improved risk stratification of patients at risk of IFI according to intensity of treatment, degree of mucositis and duration of neutropenia. These factors are currently under evaluation.Disclosures: MAS & AG are advisors to Schering-Plough & Gilead. MAS is an advisor to Pfizer.
2009

abstract No: 

M-1053

Full conference title: 

49th Annual ICAAC
    • ICAAC 49th