Approaches for using of antifungal drugs (AFD) in adult patients (pts) with newly diagnosed acute myeloid leukaemia (AML) in real clinical practice in Russia: RIFI study

Galina Klyasova, Vladimir Okhmat, Tatyana Kaporskaya, Ulia Sveshnikova, Kamil Kaplanov, Inessa Toropova, Tamara Zagoskina, Olga Korobicina, Tatyana Bogdan, Vera Larionova, Alexander Pristupa, Elena Blokhina, Elena Parovichnikova, Valeriy Savchenko


Background: The objective of this study was to evaluate approaches for using of AFD in pts with newly diagnosed AML for 6 months of chemotherapy cycles (CC) in real clinical practice in hematological centers (HC) of Russia

Material/methods: Multicenter prospective observational study RIFI (NCT01519648) was performed between February 2012 and March 2014. All pts were followed up for 6 months.

Results: A total of 808 pts from 19 hematological centers were included in RIFI study of which 262 (32%) adult pts from 14 HC had newly diagnosed AML. Within 6 months, 262 pts received 782 CC (induction I - 262, induction II - 212, consolidation I - 148, consolidation II - 116, reinduction in resistant cases 44). Granulocytopenia was in 88% of CC with comparable frequency in induction I-II (91.2%- 88.2%) and consolidation (84.5%). The median duration of granulocytopenia was 16 (1-94) days (19 and 14 days in induction I-II, 13 and 15 days in consolidation I – II, p<0.001). The prescription of antibiotics was in 90% of CC, persistent fever for more than 72 hours in 43.2%, and recurrent of febrile fever in 42.7%. AFD were not prescribed in 278 (35.5%) of CC (24% in induction I, 35% in induction II, 48% in consolidation I, 44% in consolidation II, p=0.001). The primary antifungal prophylaxis (AP) was in 29.5% (231) of CC (32-33% in induction I-II and 25.7% -24% in consolidation I-II). For prophylaxis fluconazole was used in 79.7% of CC, posaconazole in 14.7%. Secondary AP was in 2.3% (18) of CC (1.4% in induction II, 4.7% in consolidation I and 5.2% in consolidation II) and voriconazole was prescribed in 11 (61.1%) CC. Fever-driven, diagnosis-driven and targeted treatment approaches were done in 125 (16%), in 48 (6.1%), in 43 (5.5%) of CC respectively. Fever-driven treatment was with amphotericin B in 55.2% of CC, voriconazole in 13.6%, lipid complex (LC) amphotericin B in 13.6%, fluconazole in 10.4%, other AFD in 7.2%. For diagnosisdriven approaches amphotericin B was used in 60.4% of CC, voriconazole in 16.7%, LC amphotericin B in 12.5%, caspofungin in 4.2%, other AFD in 6.3%. Treatment of invasive aspergillosis (IA) was performed in 62.5% of cases by voriconazole, invasive candidiasis by caspofungin (4) and voriconazole (2). IM (proven, probable, possible) was diagnosed in 43 (16.4%) pts. Molds were in 34 (13%) pts (IA in 32 pts, mucormycoses in 1, Acremonium spp in 1), yeasts in 7 (2.7%) pts, mixed IM in 2 (0.8%) pts (1 - IA and mucormycoses, 1 – IA and candidemia).

Conclusions: Pts with newly diagnosed acute AML received AFD in 64.5% of CC. Approaches for using of antifungal drugs were primary antifungal prophylaxis (29.5%), secondary antifungal prophylaxis (2.3%), fever-driven (16%), diagnosis-driven (6.1%) and targeted treatment (5.5%).



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26th European Congress of Clinical Microbiology and Infectious Diseases
    • ECCMID 26th (2016)