Breakthrough of invasive fungal disease with posaconazole as primary prophylaxis after induction chemotherapy for acute myeloid leukemia
10.3760/cma.j.issn.0578-1426.2020.03.008
- VernacularTitle: 泊沙康唑初级预防急性髓系白血病诱导化疗后发生侵袭性真菌病的临床评估
- Author:
Renzhi PEI
1
;
Ying LU
;
Pisheng ZHANG
;
Xuhui LIU
;
Dong CHEN
;
Xiaohong DU
;
Keya SHA
;
Shuangyue LI
;
Junjie CAO
;
Lieguang CHEN
;
Xianxu ZHUANG
;
Shanhao TANG
Author Information
1. Department of Hematology, Ningbo Yinzhou People′s Hospital, Ningbo 315040, Zhejiang Province, China
- Publication Type:Journal Article
- Keywords:
Leukemia, myeloid, acute;
Posaconazole;
Invasive fungal disease
- From:
Chinese Journal of Internal Medicine
2020;59(3):213-217
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the breakthrough incidence of invasive fungal disease(IFD) and side effects of posaconazole as primary prophylaxis during induction chemotherapy for acute myeloid leukemia(AML).
Methods:A total of 206 newly diagnosed AML patients admitted to our department during January 2016 and December 2018 were enrolled in the study. Exclusive criteria were as followings including patients diagnosed as acute promyelocytic leukemia; those who received intravenous antifungal therapy after admission or had history of IFD one month before induction chemotherapy, or those with functional insufficiency of vital organs and those older than 65. Forty-seven patients received posaconazole (posaconazole group), 61 cases received voriconazole (voriconazole group) and 98 cases did not receive any prophylaxis (control group) during induction chemotherapy. Prophylactic efficacy and safety between posaconazole and voriconazole were compared.
Results:During induction chemotherapy, five possible cases of IFD occurred in posaconazole group (10.6%); while 11 cases (18.0%) were in voriconazole group including 7 possible, 3 probable and 1 proven. Thirty-five cases (35.7%) in control group were diagnosed as IFD including 19 possible, 11 probable and 5 proven ones. The incidences of IFD in posaconazole and voriconazole group were significantly lower than that in control group (P<0.05). The difference of posaconazole group and voriconazole group was not significant (P>0.05). The reported adverse events in posaconazole group were significantly lower than those in voriconazole group [12.8%(6/47) vs. 32.8%(20/61), P<0.05].
Conclusions:Posaconazole and voriconazole decrease IFD as primary prophylaxis during induction chemotherapy in patients with AML. The prophylactic effect of IFD with posaconazole is similar as voriconazole, but posaconazole shows better safety.
