The Outcome of Antifungal Prophylaxis with Posaconazole in Patients with Acute Myeloid Leukemia: A Single-Center StudyVildan Özkocaman1, Fahir Özkalemkaş1, Serdar Seyhan1, Beyza Ener2, Ahmet Ursavaş3, Tuba Ersal1, Esra Kazak4, Ezgi Demirdöğen3, Reşit Mıstık4, Halis Akalın41Uludağ University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Bursa, Turkey
2Uludağ University Faculty of Medicine, Department of Medical Microbiology, Bursa, Turkey
3Uludağ University Faculty of Medicine, Department of Chest Disease and Tuberculosis, Bursa, Turkey
4Uludağ University Faculty of Medicine, Department of Infectious Disease and Clinical Microbiology, Bursa, Turkey
Objective: Invasive fungal infections (IFIs) are a significant cause of morbidity and mortality among neutropenic patients undergoing chemotherapy for acute myeloid leukemia (AML) and stem cell transplantation. The aim of this study was to evaluate the real-life impact of posaconazole prophylaxis.
Materials and Methods: Eighty-four adult patients were included with AML under remission induction chemotherapy and posaconazole prophylaxis. The 34 patients in the control group did not receive primary antifungal prophylaxis. The period between June 2006 and January 2009, when antifungal prophylaxis was not administered (control group), was retrospectively compared to the period between December 2010 and May 2012 when primary oral posaconazole prophylaxis was administered in similar conditions (posaconazole group) according to the use of antifungal agents for treatment, breakthrough infections, galactomannan performance, and the necessity for performing bronchoalveolar lavage (BAL) procedures.
Results: The two groups were compared according to the use of antifungal agents; progression to a different antifungal agent was found in 34/34 patients (100%) in the control group and in 9/84 patients (11%) in the posaconazole group (p<0.001). There were four breakthrough IFIs (4/84, 4.8%) in the posaconazole group and 34 IFIs in the control group (p<0.001). In addition, 15/34 patients (44%) in the control group required BAL compared to 11/84 patients (13%) in the posaconazole group (p<0.001). Posaconazole treatment was discontinued within 7-14 days in 7/84 patients (8.3%) due to poor oral compliance related to mucositis after chemotherapy.
Conclusion: Posaconazole appears to be effective and well-tolerated protection against IFIs for AML patients.
Keywords: Acute myeloid leukemia, Invasive fungal infections, Antifungal prophylaxis, Posaconazole
Akut Myeloid Lösemili Hastalarda Posakonazol ile Antifungal Profilaksi Sonuçları: Tek Merkez ÇalışmasıVildan Özkocaman1, Fahir Özkalemkaş1, Serdar Seyhan1, Beyza Ener2, Ahmet Ursavaş3, Tuba Ersal1, Esra Kazak4, Ezgi Demirdöğen3, Reşit Mıstık4, Halis Akalın41Uludağ University Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Bursa, Turkey
2Uludağ University Faculty of Medicine, Department of Medical Microbiology, Bursa, Turkey
3Uludağ University Faculty of Medicine, Department of Chest Disease and Tuberculosis, Bursa, Turkey
4Uludağ University Faculty of Medicine, Department of Infectious Disease and Clinical Microbiology, Bursa, Turkey
Amaç: İnvaziv fungal enfeksiyonlar (İFE) akut myeloid lösemili (AML) ve kök hücre nakli yapılan hastalarda önemli bir mortalite ve morbidite nedenidir. Bu çalışmanın amacı posakonazol profilaksisinin gerçek yaşamdaki etkisini değerlendirmektir.
Gereç ve Yöntem: AML ve remisyon indüksiyon kemoterapisi alan ve posakonazol profilaksisi uygulanan 84 erişkin hasta çalışmaya dahil edildi. Kontrol grubunda primer antifungal profilaksi almayan 34 hasta dahil edildi. Haziran 2006 ile Ocak 2009 tarihleri arası primer oral posakonazol profilaksisi almayan (kontrol grubu) ile Aralık 2010 ile Mayıs 2012 arası primer oral posakonazol profilaksisi (posakonazol grubu) uygulanan hastaları geriye dönük olarak; tedavi için antifungal ajan kullanımı, tedavi altında (breakthrough) enfeksiyonlar, galaktomannan performansı ve bronko-alveolar lavaj (BAL) gerekliliği gibi benzer durumlar için karşılaştırdık.
Bulgular: İki grup antifungal ajan kullanımına göre karşılaştırıldığında farklı antifungal ajana geçiş kontrol grubunda 34/34 (%100) idi ve posakonazol grubunda bu oran 9/84 (%11) bulundu (p<0,001). Posakonazol grubunda 4 tedavi altında (breakthrough) IFE (4/84, %4,8) ve kontrol grubunda ise 34 İFE vardı (p<0,001). İlaveten kontrol grubunda BAL gereken hasta 15/34 (%44) iken, posakonazol grubunda BAL gerekliliği 11/84 (%13) bulundu (p<0,001). Posakonazol tedavisi hastaların 7/84’ünde (%8,3) kemoterapi sonrası mukozite bağlı oral alım bozukluğu nedeniyle 7-14 gün içinde kesilmişti.
Sonuç: Posakonazol AML’li hastaların invaziv fungal enfeksiyonlarına karşı korumada etkili ve iyi tolere ediliyor görünmektedir.
Anahtar Kelimeler: Akut myeloid lösemi, İnvaziv fungal enfeksiyonlar, Antifungal profilaksi, Posaconazol
Vildan Özkocaman, Fahir Özkalemkaş, Serdar Seyhan, Beyza Ener, Ahmet Ursavaş, Tuba Ersal, Esra Kazak, Ezgi Demirdöğen, Reşit Mıstık, Halis Akalın. The Outcome of Antifungal Prophylaxis with Posaconazole in Patients with Acute Myeloid Leukemia: A Single-Center Study. Turk J Hematol. 2018; 35(4): 277-282
Corresponding Author: Vildan Özkocaman, Türkiye |
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