'Real-life' analysis of the role of antifungal prophylaxis in preventing invasive aspergillosis in AML patients undergoing consolidation therapy

Sorveglianza Epidemiologica Infezioni nelle Emopatie (SEIFEM) 2016 study

Sorveglianza Epidemiologica Infezioni nelle Emopatie (SEIFEM) Group

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Abstract

BACKGROUND: We evaluated the incidence of proven/probable invasive aspergillosis (IA) and the role of antifungal prophylaxis (AP) in a 'real-life' setting of patients with AML receiving intensive consolidation therapy. METHODS: Cases of IA, observed during consolidation in adult/paediatric patients with AML between 2011 and 2015, were retrospectively collected in a multicentre Italian study. RESULTS: Of 2588 patients, 56 (2.2%) developed IA [43 probable (1.7%) and 13 proven (0.5%)]. IA was diagnosed in 34 of 1137 (2.9%) patients receiving no AP and in 22 of 1451 (1.5%) who were given AP (P = 0.01). Number-needed-to-treat calculation indicates that, on average, 71 patients should have received AP (instead of no AP) for one additional patient to not have IA. Initial antifungal therapy was 'pre-emptive' in 36 (64%) patients and 'targeted' in 20 (36%) patients. A good response to first-line therapy was observed in 26 (46%) patients, mainly those who received AP [16 of 22 (73%) versus 10 of 34 (29%); P = 0.001]. The overall mortality rate and the mortality rate attributable to IA by day 120 were 16% and 9%, respectively. In multivariate analysis, age ≥60 years (OR = 12.46, 95% CI = 1.13-136.73; P = 0.03) and high-dose cytarabine treatment (OR = 10.56, 95% CI = 1.95-116.74; P = 0.04) independently affected outcome. CONCLUSIONS: In our experience, AP appears to prevent IA from occurring during consolidation. However, although the incidence of IA was low, mortality was not negligible among older patients. Further prospective studies should be carried out particularly in elderly patients treated with high-dose cytarabine to confirm our data and to identify subsets of individuals who may require AP.

Original languageEnglish
Pages (from-to)1062-1068
Number of pages7
JournalThe Journal of antimicrobial chemotherapy
Volume74
Issue number4
DOIs
Publication statusPublished - Apr 1 2019

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Aspergillosis
Therapeutics
Cytarabine
Mortality
Numbers Needed To Treat
Incidence
Multicenter Studies
Multivariate Analysis
Prospective Studies
Pediatrics

ASJC Scopus subject areas

  • Pharmacology
  • Microbiology (medical)
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

@article{889822b07faf453e8d98b1a487dfad0d,
title = "'Real-life' analysis of the role of antifungal prophylaxis in preventing invasive aspergillosis in AML patients undergoing consolidation therapy: Sorveglianza Epidemiologica Infezioni nelle Emopatie (SEIFEM) 2016 study",
abstract = "BACKGROUND: We evaluated the incidence of proven/probable invasive aspergillosis (IA) and the role of antifungal prophylaxis (AP) in a 'real-life' setting of patients with AML receiving intensive consolidation therapy. METHODS: Cases of IA, observed during consolidation in adult/paediatric patients with AML between 2011 and 2015, were retrospectively collected in a multicentre Italian study. RESULTS: Of 2588 patients, 56 (2.2{\%}) developed IA [43 probable (1.7{\%}) and 13 proven (0.5{\%})]. IA was diagnosed in 34 of 1137 (2.9{\%}) patients receiving no AP and in 22 of 1451 (1.5{\%}) who were given AP (P = 0.01). Number-needed-to-treat calculation indicates that, on average, 71 patients should have received AP (instead of no AP) for one additional patient to not have IA. Initial antifungal therapy was 'pre-emptive' in 36 (64{\%}) patients and 'targeted' in 20 (36{\%}) patients. A good response to first-line therapy was observed in 26 (46{\%}) patients, mainly those who received AP [16 of 22 (73{\%}) versus 10 of 34 (29{\%}); P = 0.001]. The overall mortality rate and the mortality rate attributable to IA by day 120 were 16{\%} and 9{\%}, respectively. In multivariate analysis, age ≥60 years (OR = 12.46, 95{\%} CI = 1.13-136.73; P = 0.03) and high-dose cytarabine treatment (OR = 10.56, 95{\%} CI = 1.95-116.74; P = 0.04) independently affected outcome. CONCLUSIONS: In our experience, AP appears to prevent IA from occurring during consolidation. However, although the incidence of IA was low, mortality was not negligible among older patients. Further prospective studies should be carried out particularly in elderly patients treated with high-dose cytarabine to confirm our data and to identify subsets of individuals who may require AP.",
author = "{Sorveglianza Epidemiologica Infezioni nelle Emopatie (SEIFEM) Group} and {Del Principe}, {Maria Ilaria} and Giulia Dragonetti and Luisa Verga and Anna Candoni and Francesco Marchesi and Chiara Cattaneo and Mario Delia and Leonardo Potenza and Francesca Farina and Stelvio Ballanti and Nunzia Decembrino and Carlo Castagnola and Gianpaolo Nadali and Rosa Fanci and Enrico Orciulo and Barbara Veggia and Massimo Offidani and Lorella Melillo and Sara Manetta and Mario Tumbarello and Adriano Venditti and Alessandro Busca and Franco Aversa and Livio Pagano",
year = "2019",
month = "4",
day = "1",
doi = "10.1093/jac/dky550",
language = "English",
volume = "74",
pages = "1062--1068",
journal = "Journal of Antimicrobial Chemotherapy",
issn = "0305-7453",
publisher = "Oxford University Press",
number = "4",

}

TY - JOUR

T1 - 'Real-life' analysis of the role of antifungal prophylaxis in preventing invasive aspergillosis in AML patients undergoing consolidation therapy

T2 - Sorveglianza Epidemiologica Infezioni nelle Emopatie (SEIFEM) 2016 study

AU - Sorveglianza Epidemiologica Infezioni nelle Emopatie (SEIFEM) Group

AU - Del Principe, Maria Ilaria

AU - Dragonetti, Giulia

AU - Verga, Luisa

AU - Candoni, Anna

AU - Marchesi, Francesco

AU - Cattaneo, Chiara

AU - Delia, Mario

AU - Potenza, Leonardo

AU - Farina, Francesca

AU - Ballanti, Stelvio

AU - Decembrino, Nunzia

AU - Castagnola, Carlo

AU - Nadali, Gianpaolo

AU - Fanci, Rosa

AU - Orciulo, Enrico

AU - Veggia, Barbara

AU - Offidani, Massimo

AU - Melillo, Lorella

AU - Manetta, Sara

AU - Tumbarello, Mario

AU - Venditti, Adriano

AU - Busca, Alessandro

AU - Aversa, Franco

AU - Pagano, Livio

PY - 2019/4/1

Y1 - 2019/4/1

N2 - BACKGROUND: We evaluated the incidence of proven/probable invasive aspergillosis (IA) and the role of antifungal prophylaxis (AP) in a 'real-life' setting of patients with AML receiving intensive consolidation therapy. METHODS: Cases of IA, observed during consolidation in adult/paediatric patients with AML between 2011 and 2015, were retrospectively collected in a multicentre Italian study. RESULTS: Of 2588 patients, 56 (2.2%) developed IA [43 probable (1.7%) and 13 proven (0.5%)]. IA was diagnosed in 34 of 1137 (2.9%) patients receiving no AP and in 22 of 1451 (1.5%) who were given AP (P = 0.01). Number-needed-to-treat calculation indicates that, on average, 71 patients should have received AP (instead of no AP) for one additional patient to not have IA. Initial antifungal therapy was 'pre-emptive' in 36 (64%) patients and 'targeted' in 20 (36%) patients. A good response to first-line therapy was observed in 26 (46%) patients, mainly those who received AP [16 of 22 (73%) versus 10 of 34 (29%); P = 0.001]. The overall mortality rate and the mortality rate attributable to IA by day 120 were 16% and 9%, respectively. In multivariate analysis, age ≥60 years (OR = 12.46, 95% CI = 1.13-136.73; P = 0.03) and high-dose cytarabine treatment (OR = 10.56, 95% CI = 1.95-116.74; P = 0.04) independently affected outcome. CONCLUSIONS: In our experience, AP appears to prevent IA from occurring during consolidation. However, although the incidence of IA was low, mortality was not negligible among older patients. Further prospective studies should be carried out particularly in elderly patients treated with high-dose cytarabine to confirm our data and to identify subsets of individuals who may require AP.

AB - BACKGROUND: We evaluated the incidence of proven/probable invasive aspergillosis (IA) and the role of antifungal prophylaxis (AP) in a 'real-life' setting of patients with AML receiving intensive consolidation therapy. METHODS: Cases of IA, observed during consolidation in adult/paediatric patients with AML between 2011 and 2015, were retrospectively collected in a multicentre Italian study. RESULTS: Of 2588 patients, 56 (2.2%) developed IA [43 probable (1.7%) and 13 proven (0.5%)]. IA was diagnosed in 34 of 1137 (2.9%) patients receiving no AP and in 22 of 1451 (1.5%) who were given AP (P = 0.01). Number-needed-to-treat calculation indicates that, on average, 71 patients should have received AP (instead of no AP) for one additional patient to not have IA. Initial antifungal therapy was 'pre-emptive' in 36 (64%) patients and 'targeted' in 20 (36%) patients. A good response to first-line therapy was observed in 26 (46%) patients, mainly those who received AP [16 of 22 (73%) versus 10 of 34 (29%); P = 0.001]. The overall mortality rate and the mortality rate attributable to IA by day 120 were 16% and 9%, respectively. In multivariate analysis, age ≥60 years (OR = 12.46, 95% CI = 1.13-136.73; P = 0.03) and high-dose cytarabine treatment (OR = 10.56, 95% CI = 1.95-116.74; P = 0.04) independently affected outcome. CONCLUSIONS: In our experience, AP appears to prevent IA from occurring during consolidation. However, although the incidence of IA was low, mortality was not negligible among older patients. Further prospective studies should be carried out particularly in elderly patients treated with high-dose cytarabine to confirm our data and to identify subsets of individuals who may require AP.

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U2 - 10.1093/jac/dky550

DO - 10.1093/jac/dky550

M3 - Article

VL - 74

SP - 1062

EP - 1068

JO - Journal of Antimicrobial Chemotherapy

JF - Journal of Antimicrobial Chemotherapy

SN - 0305-7453

IS - 4

ER -