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

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)

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.
2012

abstract No: 

P867

Full conference title: 

22nd European Congress of Clinical Microbiology and Infectious Diseases
    • ECCMID 22nd (2012)