Real-life comparison of posaconazole versus fluconazole for primary antifungal prophylaxis during remission-induction chemotherapy for acute leukemia

Patients undergoing remission-induction intensive chemotherapy for acute leukemia are at high risk for life-threatening invasive fungal infections (IFIs). Primary antifungal prophylaxis with posaconazole has been shown to reduce the incidence of IFI compared to fluconazole, but real-life data are li...

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Bibliographic Details
Published in:Journal of the Association of Medical Microbiology and Infectious Disease Canada = Journal officiel de l'Association pour la microbiologie médicale et l'infectiologie Canada 2023-03, Vol.8 (1), p.18-28
Main Authors: Dufresne, Simon F, Bergeron, Julie, Beauchemin, Stéphanie, Abou Chakra, Claire Nour, Vadnais, Barbara, Bouchard, Philippe, Labbé, Annie-Claude, Laverdière, Michel
Format: Article
Language:English
Subjects:
Acute leukemia
Antimitotic agents
Antineoplastic agents
Canada
Cancer
Chemotherapy
Comparative analysis
Fluconazole
Health aspects
Infection
Mortality
Original Research
Posaconazole
Quebec
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Summary:Patients undergoing remission-induction intensive chemotherapy for acute leukemia are at high risk for life-threatening invasive fungal infections (IFIs). Primary antifungal prophylaxis with posaconazole has been shown to reduce the incidence of IFI compared to fluconazole, but real-life data are limited and the effect on mortality remains unclear. This retrospective cohort study compared fluconazole and posaconazole as primary prophylaxis in real-life practice over a 10-year period, in a Canadian hospital. A total of 299 episodes were included (fluconazole, = 98; posaconazole, = 201), of which 68% were first inductions. The underlying hematologic malignancy was acute myeloid leukemia or myelodysplastic syndrome in 88% of episodes and acute lymphoblastic leukemia in 9%. Overall, 20 cases of IFI occurred (aspergillosis, = 17; candidiasis, = 3) and 14 were considered as breakthrough IFI. IFI incidence was significantly lower in the posaconazole group (3.5% versus 13.2%; = 0.001). Empirical or targeted antifungal therapy was also reduced in the posaconazole cohort. Mortality was similar in both groups. In a real-life setting in Canada, primary posaconazole prophylaxis reduces the incidence of IFI during remission-induction chemotherapy, compared to fluconazole.
ISSN:2371-0888
2371-0888
DOI:10.3138/jammi-2022-0027