Empirical Vs. Prophylactic Antifungal Strategies: Comparison of Effectiveness In High Risk AML Patients at a Tertiary Cancer Center

Dennis Gutmann1*, Jan Felix Kersten2*, Philippe Schafhausen, MD3*, Tim H. Brummendorf, MD4, Martin Trepel, MD, PhD5, Carsten Bokemeyer, MD6* and Jens Panse, MD7*

Author address: 

1Oncology/Hematology, Uinversity Hospital Hamburg Eppendorf, Hamburg, Germany 2Medical Biometry and Epidemiology, University Hospital Hamburg Eppendorf, Hamburg 3Universitätsklinikum Hamburg Eppendorf, Medizinische Klinik II, Hamburg, Germany 4Uni

Abstract: 

Objectives: Invasive fungal infections (IFI) remain a major threat for patients with acute myelogenious leukemia (AML). Since the publication of two landmark studies, which demonstrated a reduction in morbidity and mortality from IFI in high risk patients through prophylaxis with posaconazole, guidelines have recommend routine prophylaxis with posaconazole during induction chemotherapy. However, prompt empirical or pre-emptive therapy strategies are still commonly used alternatives. Real life data about posaconazole prophylaxis are scarce and potential overtreatment, increasing costs and development of resistant fungi are of concern. We therefore compared effectiveness of empirical and prophylactic antifungal strategies at a tertiary cancer center during a phase of intensive building (re-) construction Methods: 104 patients (pts.) with AML treated between January 2005 and February 2009 were retrospectively evaluated. Each induction chemotherapy or consolidation therapy with neutropenia >=10 days was counted as an episode (n=222). Patients were stratified according to their antifungal approach: primary prophylaxis (n=35, 51 episodes; group 1), empirical therapy (n=63, 111 indices; group 2), secondary prophylaxis (n=41, 60 episodes; group 3, which comprised of patients from groups 1 and 2). Group 1 received posaconazole 3 x 200 mg p.o.; group 2 received topical polyene prophylaxis and empirical treatment with voriconazole or fluconazole. Patients in group 3 received either voriconazole, posaconazole, fluconazole or intraconazole. Results: Demographics, AML subtypes, co-morbidities and neutropenic days (median = 13) were comparable in all three groups; no patient received G-CSF support. Logistic regression analysis revealed days of neutropenia, performance status, use of antibiotics and secondary AML as risk factors for development of IFI, while primary prophylaxis reduced the risk for possible/probable/proven IFI by 86,7% compared to empirical therapy (p=0.001). Incidences of probable/proven IFI were 3% in group 1, 29% in group 2 and 7% in group 3 (p=0.001) and 17%, 69% and 37% (p
2010

abstract No: 

1729

Full conference title: 

52nd American Society of Haematologists Annual Meeting
    • ASH 52nd (2010)