Comparative clinical effectiveness of prophylactic voriconazole/posaconazole to fluconazole/itraconazole in patients with acute myeloid leukemia/myelodysplastic syndrome undergoing cytotoxic chemotherapy over a 12-year period

• Published in: Haematologica (Roma) Vol. 97; no. 3; pp. 459 - 463
• Main Authors: ANANDA-RAJAH, Michelle R, GRIGG, Andrew, DOWNEY, Maria T, BAJEL, Ashish, SPELMAN, Tim, CHENG, Allen, THURSKY, Karin T, VINCENT, Janette, SLAVIN, Monica A
• Format: Journal Article
• Language: English
• Published: Pavia Ferrata Storti Foundation 01.03.2012
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Antibiotic Prophylaxis; Antifungal Agents - pharmacokinetics; Antifungal Agents - therapeutic use; Biological and medical sciences; Female; Fluconazole - pharmacokinetics; Fluconazole - therapeutic use; Hematologic and hematopoietic diseases; Humans; Itraconazole - pharmacokinetics; Itraconazole - therapeutic use; Leukemia, Myeloid, Acute - complications; Leukemia, Myeloid, Acute - drug therapy; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Medication Adherence; Middle Aged; Mycoses - complications; Mycoses - prevention & control; Myelodysplastic Syndromes - complications; Myelodysplastic Syndromes - drug therapy; Original and Brief Reports; Pyrimidines - pharmacokinetics; Pyrimidines - therapeutic use; Retrospective Studies; Treatment Outcome; Triazoles - pharmacokinetics; Triazoles - therapeutic use; Voriconazole; Young Adult; Human; Acute myelogenous leukemia; Fluconazole; Hematology; Mycosis; Azole derivatives; Cytotoxicity; Malignant hemopathy; prophylaxis; Myelodysplastic syndrome; fungal infections; Infection; Prevention; Antifungal agent; Chemotherapy; Treatment; acute myeloid leukemia; Voriconazole; Triazole derivatives; Posaconazole; Comparative study; Cancer; Itraconazole
• ISSN: 0390-6078; 1592-8721
• DOI: 10.3324/haematol.2011.051995

Post-induction aplasia for acute myeloid leukemia/myelodysplastic syndrome is a high-risk period for invasive fungal diseases. The effectiveness of fluconazole, itraconazole solution, voriconazole and posaconazole prophylaxis used consecutively from December 1998 to January 2010 in patients with acute myeloid leukemia/myelodysplastic syndrome undergoing remission-induction chemotherapy was retrospectively evaluated. A total of 216 consecutive patients received 573 prophylaxis courses. Breakthrough-invasive fungal disease incidence in fluconazole, itraconazole, voriconazole, posaconazole recipients was 25%, 16%, 14% and 3%, respectively. Voriconazole/posconazole versus fluconazole/itraconazole combined was associated with significant reductions in breakthrough-invasive fungal disease incidence (20% vs. 8%, P=0.011), premature discontinuations (46% vs. 22% P<0.001) and empiric antifungal treatment (31% vs. 8.5%, P<0.001). Microbiologically confirmed infections were molds. Posaconazole compared to other drugs was associated with fewer courses requiring computed-tomography (43% vs. 26%, P<0.001). Adoption of voriconazole/posaconazole has decreased invasive fungal disease incidence, empiric antifungal treatment and for posaconazole, computed-tomography demand, with effectiveness of posaconazole comparable to clinical trial experience.