Decreased invasive fungal disease but no impact on overall survival by posaconazole compared to fluconazole prophylaxis: a retrospective cohort study in patients receiving induction therapy for acute myeloid leukaemia/myelodysplastic syndromes

被引:19
作者
Dahlen, Torsten [1 ]
Kalin, Mats [2 ]
Cederlund, Kerstin [3 ]
Nordlander, Anna [4 ]
Bjorkholm, Magnus [1 ]
Ljungman, Per [5 ]
Blennow, Ola [4 ]
机构
[1] Karolinska Univ Hosp, Karolinska Inst, Dept Med Solna, Div Hematol, SE-14186 Stockholm, Sweden
[2] Karolinska Univ Hosp, Karolinska Inst, Dept Med Solna, Infect Dis Unit, SE-14186 Stockholm, Sweden
[3] Karolinska Univ Hosp, Karolinska Inst, Dept Clin Sci Intervent & Technol, Div Med Imaging & Technol, SE-14186 Stockholm, Sweden
[4] Karolinska Univ Hosp, Karolinska Inst, Dept Med Huddinge, Infect Dis Unit, SE-14186 Stockholm, Sweden
[5] Karolinska Univ Hosp, Karolinska Inst, Dept Med Huddinge, Div Hematol, SE-14186 Stockholm, Sweden
关键词
posaconazole; fluconazole; prophylaxis; neutropenia; acute myeloid leukaemia; invasive fungal disease; invasive aspergillosis; ACUTE MYELOGENOUS LEUKEMIA; CLINICAL EFFECTIVENESS; VS; FLUCONAZOLE; CHEMOTHERAPY; ASPERGILLOSIS; INFECTIONS; EXPERIENCE;
D O I
10.1111/ejh.12565
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: Posaconazole prophylaxis during induction chemotherapy for acute myeloid leukaemia (AML) and myelodysplastic syndromes (MDS) has been shown to significantly decrease the incidence of invasive fungal disease (IFD) and increase overall survival in a trial setting, but only small real-life studies have been published. Methods: This was a retrospective cohort study including consecutive patients with AML/MDS treated with intensive induction chemotherapy; 176 patients received fluconazole prophylaxis 2008-2011 and 107 patients received posaconazole prophylaxis 2011-2013. Only proven and probable IFD according to the revised EORTC/MSG criteria were included in the analysis. Results: The two cohorts were well matched without significant differences in patient characteristics. At day 100, patients receiving posaconazole had a significantly lower incidence of total IFD (0.9% vs. 10.8%, P < 0.01), invasive aspergillosis (0% vs. 5.7%, P = 0.02) and invasive candidiasis (0% vs. 4.0%, P < 0.05). There was no significant difference in overall survival, neither at day 100 (87% in the posaconazole group vs. 85% in the fluconazole group) nor at end of follow-up (78% vs. 77%). Conclusions: Posaconazole prophylaxis decreased the incidence of IFD but did not improve short-term overall survival. Improved treatment efficacy of manifest IFD is likely to explain the lack of survival benefit.
引用
收藏
页码:175 / 180
页数:6
相关论文
共 19 条
  • [1] 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
    Ananda-Rajah, Michelle R.
    Grigg, Andrew
    Downey, Maria T.
    Bajel, Ashish
    Spelman, Tim
    Cheng, Allen
    Thursky, Karin T.
    Vincent, Janette
    Slavin, Monica A.
    [J]. HAEMATOLOGICA-THE HEMATOLOGY JOURNAL, 2012, 97 (03): : 459 - 463
  • [2] [Anonymous], 2013, NCCN Clinical Practice Guidelines in Oncology: Survivorship
  • [3] Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia
    Cornely, Oliver A.
    Maertens, Johan
    Winston, Drew J.
    Perfect, John
    Ullmann, Andrew J.
    Walsh, Thomas J.
    Helfgott, David
    Holowiecki, Jerzy
    Stockelberg, Dick
    Goh, Yeow-Tee
    Petrini, Mario
    Hardalo, Cathy
    Suresh, Ramachandran
    Angulo-Gonzalez, David
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2007, 356 (04) : 348 - 359
  • [4] Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group
    De Pauw, Ben
    Walsh, Thomas J.
    Donnelly, J. Peter
    Stevens, David A.
    Edwards, John E.
    Calandra, Thierry
    Pappas, Peter G.
    Maertens, Johan
    Lortholary, Olivier
    Kauffman, Carol A.
    Denning, David W.
    Patterson, Thomas F.
    Maschmeyer, Georg
    Bille, Jacques
    Dismukes, William E.
    Herbrecht, Raoul
    Hope, William W.
    Kibbler, Christopher C.
    Kullberg, Bart Jan
    Marr, Kieren A.
    Munoz, Patricia
    Odds, Frank C.
    Perfect, John R.
    Restrepo, Angela
    Ruhnke, Markus
    Segal, Brahm H.
    Sobel, Jack D.
    Sorrell, Tania C.
    Viscoli, Claudio
    Wingard, John R.
    Zaoutis, Theoklis
    Bennett, John E.
    [J]. CLINICAL INFECTIOUS DISEASES, 2008, 46 (12) : 1813 - 1821
  • [5] Improved patient survival for acute myeloid leukemia: a population-based study of 9729 patients diagnosed in Sweden between 1973 and 2005
    Derolf, Asa Rangert
    Kristinsson, Sigurdur Yngvi
    Andersson, Therese M. -L.
    Landgren, Ola
    Dickman, Paul W.
    Bjorkholm, Magnus
    [J]. BLOOD, 2009, 113 (16) : 3666 - 3672
  • [6] Diagnosis and management of acute myeloid leukemia in adults: recommendations from an international expert panel, on behalf of the European LeukemiaNet
    Doehner, Hartmut
    Estey, Elihu H.
    Amadori, Sergio
    Appelbaum, Frederick R.
    Buechner, Thomas
    Burnett, Alan K.
    Dombret, Herve
    Fenaux, Pierre
    Grimwade, David
    Larson, Richard A.
    Lo-Coco, Francesco
    Naoe, Tomoki
    Niederwieser, Dietger
    Ossenkoppele, Gert J.
    Sanz, Miguel A.
    Sierra, Jorge
    Tallman, Martin S.
    Loewenberg, Bob
    Bloomfield, Clara D.
    [J]. BLOOD, 2010, 115 (03) : 453 - 474
  • [7] Impact of invasive fungal disease on the chemotherapy schedule and event-free survival in acute leukemia patients who survived fungal disease: a case-control study
    Even, Caroline
    Bastuji-Garin, Sylvie
    Hicheri, Yosr
    Pautas, Cecile
    Botterel, Francoise
    Maury, Sebastien
    Cabanne, Ludovic
    Bretagne, Stephane
    Cordonnier, Catherine
    [J]. HAEMATOLOGICA-THE HEMATOLOGY JOURNAL, 2011, 96 (02): : 337 - 341
  • [8] Posaconazole prophylaxis during front-line chemotherapy of acute myeloid leukemia: a single-center, real-life experience
    Girmenia, Corrado
    Frustaci, Anna Maria
    Gentile, Giuseppe
    Minotti, Clara
    Cartoni, Claudio
    Capria, Saveria
    Trisolini, Silvia Maria
    Matturro, Angela
    Loglisci, Giuseppina
    Latagliata, Roberto
    Breccia, Massimo
    Meloni, Giovanna
    Alimena, Giuliana
    Foa, Robin
    Micozzi, Alessandra
    [J]. HAEMATOLOGICA-THE HEMATOLOGY JOURNAL, 2012, 97 (04): : 560 - 567
  • [9] A systematic review of quasi-experimental study designs in the fields of infection control and antibiotic resistance
    Harris, AD
    Lautenbach, E
    Perencevich, E
    [J]. CLINICAL INFECTIOUS DISEASES, 2005, 41 (01) : 77 - 82
  • [10] Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis
    Herbrecht, R
    Denning, DW
    Patterson, TF
    Bennett, JE
    Greene, RE
    Oestmann, JW
    Kern, WV
    Marr, KA
    Ribaud, P
    Lortholary, O
    Sylvester, R
    Rubin, RH
    Wingard, JR
    Stark, P
    Durand, C
    Caillot, D
    Thiel, E
    Chandrasekar, PH
    Hodges, MR
    Schlamm, HT
    Troke, PF
    de Pauw, B
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2002, 347 (06) : 408 - 415