Systemic antifungal treatment after posaconazole prophylaxis

results from the SEIFEM 2010-C survey

Livio Pagano, Luisa Verga, Alessandro Busca, Bruno Martino, Maria E nza Mitra, Rosa Fanci, Stelvio Ballanti, Marco Picardi, Carlo Castagnola, Chiara Cattaneo, Gianpaolo Nadali, Annamaria Nosari, Anna Candoni, Morena Caira, Prassede Salutari, Federica Lessi, Franco Aversa, Mario Tumbarello

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

OBJECTIVES: To investigate the incidence, treatment and outcome of breakthrough invasive fungal infections (IFIs) in adult acute myeloid leukaemia (AML) patients after posaconazole prophylaxis.

METHODS: From January 2010 to April 2012, all consecutive patients with newly diagnosed AML were prospectively registered at 33 participating Italian centres. All cases of IFIs occurring within 30 days after the end of the first induction chemotherapy were recorded. The strategy of antifungal treatment (empirical, pre-emptive or targeted) and the drugs used were analysed. ClinicalTrials.gov code: NCT01315925.

RESULTS: In total, 1192 patients with newly diagnosed AML were enrolled in the study, of whom 510 received posaconazole prophylaxis and were included in the present analysis. Of these patients, 140 (27%) needed systemic antifungal treatment. Among the 127 evaluable cases, an empirical approach was utilized in 102 patients (80%), a pre-emptive approach in 19 patients (15%) and targeted therapy in 6 patients (5%). Only five patients died of IFIs (three in the empirical group and two in the targeted group; 4%). A critical review of IFI diagnoses at 30 days demonstrated that among the patients treated empirically, ∼30% were not affected by IFIs but rather only by fever of unidentified origin. A comparison between the empirical and the pre-emptive groups showed no significant differences regarding the attributable and overall mortalities.

CONCLUSIONS: This study confirms that posaconazole prophylaxis reduces the incidence of breakthrough IFIs and does not modify the efficacy of subsequent systemic antifungal treatment, regardless of the approach (empirical or pre-emptive) or the antifungal drug used.

Original languageEnglish
Pages (from-to)3142-3147
Number of pages6
JournalJournal of Antimicrobial Chemotherapy
Volume69
Issue number11
DOIs
Publication statusPublished - Nov 1 2014

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Acute Myeloid Leukemia
Therapeutics
Surveys and Questionnaires
posaconazole
Induction Chemotherapy
Incidence
Pharmaceutical Preparations
Invasive Fungal Infections
Fever
Mortality

Keywords

  • acute myeloid leukaemia
  • antifungal prophylaxis
  • empirical therapy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Pagano, L., Verga, L., Busca, A., Martino, B., Mitra, M. E. N., Fanci, R., ... Tumbarello, M. (2014). Systemic antifungal treatment after posaconazole prophylaxis: results from the SEIFEM 2010-C survey. Journal of Antimicrobial Chemotherapy, 69(11), 3142-3147. https://doi.org/10.1093/jac/dku227

Systemic antifungal treatment after posaconazole prophylaxis : results from the SEIFEM 2010-C survey. / Pagano, Livio; Verga, Luisa; Busca, Alessandro; Martino, Bruno; Mitra, Maria E nza; Fanci, Rosa; Ballanti, Stelvio; Picardi, Marco; Castagnola, Carlo; Cattaneo, Chiara; Nadali, Gianpaolo; Nosari, Annamaria; Candoni, Anna; Caira, Morena; Salutari, Prassede; Lessi, Federica; Aversa, Franco; Tumbarello, Mario.

In: Journal of Antimicrobial Chemotherapy, Vol. 69, No. 11, 01.11.2014, p. 3142-3147.

Research output: Contribution to journalArticle

Pagano, L, Verga, L, Busca, A, Martino, B, Mitra, MEN, Fanci, R, Ballanti, S, Picardi, M, Castagnola, C, Cattaneo, C, Nadali, G, Nosari, A, Candoni, A, Caira, M, Salutari, P, Lessi, F, Aversa, F & Tumbarello, M 2014, 'Systemic antifungal treatment after posaconazole prophylaxis: results from the SEIFEM 2010-C survey', Journal of Antimicrobial Chemotherapy, vol. 69, no. 11, pp. 3142-3147. https://doi.org/10.1093/jac/dku227
Pagano, Livio ; Verga, Luisa ; Busca, Alessandro ; Martino, Bruno ; Mitra, Maria E nza ; Fanci, Rosa ; Ballanti, Stelvio ; Picardi, Marco ; Castagnola, Carlo ; Cattaneo, Chiara ; Nadali, Gianpaolo ; Nosari, Annamaria ; Candoni, Anna ; Caira, Morena ; Salutari, Prassede ; Lessi, Federica ; Aversa, Franco ; Tumbarello, Mario. / Systemic antifungal treatment after posaconazole prophylaxis : results from the SEIFEM 2010-C survey. In: Journal of Antimicrobial Chemotherapy. 2014 ; Vol. 69, No. 11. pp. 3142-3147.
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abstract = "OBJECTIVES: To investigate the incidence, treatment and outcome of breakthrough invasive fungal infections (IFIs) in adult acute myeloid leukaemia (AML) patients after posaconazole prophylaxis.METHODS: From January 2010 to April 2012, all consecutive patients with newly diagnosed AML were prospectively registered at 33 participating Italian centres. All cases of IFIs occurring within 30 days after the end of the first induction chemotherapy were recorded. The strategy of antifungal treatment (empirical, pre-emptive or targeted) and the drugs used were analysed. ClinicalTrials.gov code: NCT01315925.RESULTS: In total, 1192 patients with newly diagnosed AML were enrolled in the study, of whom 510 received posaconazole prophylaxis and were included in the present analysis. Of these patients, 140 (27{\%}) needed systemic antifungal treatment. Among the 127 evaluable cases, an empirical approach was utilized in 102 patients (80{\%}), a pre-emptive approach in 19 patients (15{\%}) and targeted therapy in 6 patients (5{\%}). Only five patients died of IFIs (three in the empirical group and two in the targeted group; 4{\%}). A critical review of IFI diagnoses at 30 days demonstrated that among the patients treated empirically, ∼30{\%} were not affected by IFIs but rather only by fever of unidentified origin. A comparison between the empirical and the pre-emptive groups showed no significant differences regarding the attributable and overall mortalities.CONCLUSIONS: This study confirms that posaconazole prophylaxis reduces the incidence of breakthrough IFIs and does not modify the efficacy of subsequent systemic antifungal treatment, regardless of the approach (empirical or pre-emptive) or the antifungal drug used.",
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AU - Pagano, Livio

AU - Verga, Luisa

AU - Busca, Alessandro

AU - Martino, Bruno

AU - Mitra, Maria E nza

AU - Fanci, Rosa

AU - Ballanti, Stelvio

AU - Picardi, Marco

AU - Castagnola, Carlo

AU - Cattaneo, Chiara

AU - Nadali, Gianpaolo

AU - Nosari, Annamaria

AU - Candoni, Anna

AU - Caira, Morena

AU - Salutari, Prassede

AU - Lessi, Federica

AU - Aversa, Franco

AU - Tumbarello, Mario

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N2 - OBJECTIVES: To investigate the incidence, treatment and outcome of breakthrough invasive fungal infections (IFIs) in adult acute myeloid leukaemia (AML) patients after posaconazole prophylaxis.METHODS: From January 2010 to April 2012, all consecutive patients with newly diagnosed AML were prospectively registered at 33 participating Italian centres. All cases of IFIs occurring within 30 days after the end of the first induction chemotherapy were recorded. The strategy of antifungal treatment (empirical, pre-emptive or targeted) and the drugs used were analysed. ClinicalTrials.gov code: NCT01315925.RESULTS: In total, 1192 patients with newly diagnosed AML were enrolled in the study, of whom 510 received posaconazole prophylaxis and were included in the present analysis. Of these patients, 140 (27%) needed systemic antifungal treatment. Among the 127 evaluable cases, an empirical approach was utilized in 102 patients (80%), a pre-emptive approach in 19 patients (15%) and targeted therapy in 6 patients (5%). Only five patients died of IFIs (three in the empirical group and two in the targeted group; 4%). A critical review of IFI diagnoses at 30 days demonstrated that among the patients treated empirically, ∼30% were not affected by IFIs but rather only by fever of unidentified origin. A comparison between the empirical and the pre-emptive groups showed no significant differences regarding the attributable and overall mortalities.CONCLUSIONS: This study confirms that posaconazole prophylaxis reduces the incidence of breakthrough IFIs and does not modify the efficacy of subsequent systemic antifungal treatment, regardless of the approach (empirical or pre-emptive) or the antifungal drug used.

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KW - empirical therapy

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