gms | German Medical Science

18th Symposium on Infections in the Immunocompromised Host

International Immunocompromised Host Society

15. to 17.06.2014, Berlin

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Posaconazole versus Fluconazole or Itraconazole Prophylaxis in Patients with Acute Myeloid Leukemia or Myelodysplastic Syndrome Undergoing Cytotoxic Chemotherapy: Perspectives in Korea

Meeting Abstract

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  • Dong-Gun Lee - Division of Infectious Diseases, Department of Internal Medicine, The Catholic Blood and Marrow Transplantation Center, Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
  • Sung-Yeon Cho - Korea
  • Jae-Ki Choi - Korea
  • Hyo-Jin Lee - Division of Infectious Diseases, Department of Internal Medicine, The Catholic Blood and Marrow Transplantation Center, Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
  • Su-Mi Choi - Korea

18th Symposium on Infections in the Immunocompromised Host. Berlin, 15.-17.06.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc14ichs32

doi: 10.3205/14ichs32, urn:nbn:de:0183-14ichs320

Veröffentlicht: 3. Juni 2014

© 2014 Lee et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.

Gliederung

Text

Background: Invasive fungal infections (IFIs) still remain as a leading cause of morbidity and mortality in patients with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) undergoing remission-induction chemotherapy. From 2013, primary antifungal prophylaxis (PAP) using posaconazole (PCZ) has become available in Korea. The aim of this study was to evaluate and compare the clinical effectiveness of PCZ and fluconazole (FCZ) or itraconazole (ITZ) PAP during cytotoxic chemotherapy in AML/MDS cohort.

Methods: We retrospectively reviewed all consecutive patients with AML/MDS undergoing remission induction or reinduction chemotherapy between December 2010 and November 2013. We included only the first episode of PAP if one patient received two or more times of cytotoxic chemotherapies. To determine the efficacy of PAP, we analyzed the incidence of breakthrough IFIs, empiric antifungal treatment (EAFT) and mortality in the cohort.

Results: A total of 460 patients were included. During the study period, PCZ was used in 145 patients and FCZ or ITZ were used in 315 patients. There was no difference in baseline characteristics between PCZ and FCZ/ITZ group. In PCZ group, proven, probable and possible IFIs were developed in 0.7%, 2.1% and 6.9%, respectively. There were significant differences in the incidence of proven or probable IFIs between PCZ group and FCZ/ITZ group (2.8% vs. 14.0%, OR 0.175, 95% CI 0.062-0.496; p<0.001). PCZ PAP was associated with significant decrease in EAFT (15.3% vs. 46.0%, OR 0.210, 95% CI 0.127-0.347; p<0.001). In-hospital mortality was not significantly different between the two groups (9.7% vs. 12.1%, OR 0.779; 95% CI 0.408-1.488; p=0.449).

Conclusion: PCZ PAP may decrease IFIs and EAFT in patients with AML/MDS remission-induction or reinduction chemotherapy. Survival benefit of this new azole prophylaxis needs to be further evaluated.

Key words: Leukemia, Myeloid, Acute; Mycoses; Posaconazole; Prophylaxis