Antifungal prophylaxis in newly diagnosed AML patients–Adherence to guidelines and feasibility in a real life setting

Abstract

Antifungal posaconazole prophylaxis for AML patients receiving induction chemotherapy has been routine at our centre since 2009. This retrospective study examined the feasibility and practicability of our prophylaxis guidelines in clinical practice. Data sets of 90 patients undergoing induction-chemotherapy for AML between 2011 and 2014 were evaluated regarding adherence to local guidelines for the administration of antifungal prophylaxis with posaconazole. 75.5% of the 90 patients received posaconazole prophylaxis. All but eight patients received the recommended dosage. A total of 77.95% on prophylaxis had serum galactomannan measured twice weekly. Contradicting our guidelines, 89.70% of patients received concomitant therapy with PPI. Overall, 16.17% of patients had prophylaxis discontinued and started empirical antifungal treatment in the absence of diagnostic criteria for IFI. The breakthrough IFI rate was 36.76% (proven, probable and possible) with 7.35% of infections being classified as proven or probable. Although limited by a small sample size, our study demonstrates the feasibility of local guidelines in a real life setting and outlines areas for improvement in both guidelines and clinical practice. We also highlight the importance of ensuring awareness of guidelines and raise questions about a uniform approach to antifungal prophylaxis in AML patients.

Clinical Outcomes of Oral Suspension versus Delayed-Release Tablet Formulations of Posaconazole for Prophylaxis of Invasive Fungal Infections

“…The primary documented rationales for early discontinuation were elevated liver function tests, an inability to take an oral formulation, and drug cost. There were no significant differences in the frequency or distribution of the rationale for early discontinuation between formulations, which is consistent with the findings reported from previous studies ( 9 , 21 ). Evaluation of the clinical outcomes of patients that discontinued posaconazole was beyond the scope of this study, but they should be explored to better understand the relative trade-offs between those outcomes and the rationale for discontinuation.…”

The Outcome of Antifungal Prophylaxis with Posaconazole in Patients with Acute Myeloid Leukemia: A Single Center Study

“…This study showed that antifungal prophylaxis with posaconazole significantly reduced IFIs and the need for antifungal treatment. Several recent studies supported the finding that posaconazole prophylaxis reduces the incidence of IFIs and invasive aspergillus in patients with AML/MDS or hematopoietic cell transplantation recipients when tested against comparable antifungal agents [ 16 , 17 , 18 ]. Prophylactic posaconazole was associated with statistically significantly fewer febrile days, shorter duration of hospitalization, and longer fungal-free survival; however, overall and attributable mortality did not differ [ 19 ].…”

Antifungal treatment in haematological and oncological patients: Need for quality assessment in routine care

“…presented inadequacies in indication (16%), drug selection (31%) and dosing (16%) of antifungal agents in medical departments, haematology/oncology and intensive care units. Berking et al . documented non‐adherence to guidelines in 24.5% of patients with AML receiving POS prophylaxis.…”