Assessing the impact of prophylactic anidulafungin during remission induction of acute myeloid leukemia - A propensity-score matching analysis
Copyright © 2023 SFMM. Published by Elsevier Masson SAS. All rights reserved..
INTRODUCTION: Invasive fungal infection (IFI) accounts for substantial morbidity during the treatment of acute myeloid leukemia (AML) in adults. Antifungal prophylaxis (AP) is needed during intensive chemotherapy, and posaconazole is not widely available. In this study, we aimed to examine the impact of prophylactic anidulafungin during intensive AML remission induction.
METHODS: This is a retrospective cohort encompassing newly diagnosed AML adult patients. All subjects received intensive chemotherapy and were divided into three groups: patients who did not receive any AP and patients who received fluconazole (150-400 mg/day) or anidulafungin (100 mg/day).
RESULTS: During AML induction, 82 patients did not receive AP, 108 and 14 patients received anidulafungin and fluconazole, respectively. IFI incidence was 27%, classified as possible, probable, and proven in 65, 2 and 33%, respectively. Multivariable analysis showed that lower neutrophil counts are associated with IFI (OR = 2.8), whereas age, genetic classification, and lymphocyte counts were not. To examine the impact of anidulafungin in comparison with 'no AP', a propensity score matching analysis was performed. Use of anidulafungin was not related to less IFI during induction, while neutrophil counts remained significant. Patients under prophylactic anidulafungin received less amphotericin B (p < 0.001) but not voriconazole (p = 0.49).
DISCUSSION: To our knowledge, this is the first study addressing the role of anidulafungin during AML induction. Here, the incidence of mold infections did not decrease with AP, suggesting that in a setting with a high incidence of IFI, broad spectrum AP might be more suitable.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:33 |
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| Enthalten in: |
Journal de mycologie medicale - 33(2023), 4 vom: 03. Nov., Seite 101434 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Silva, Wellington Fernandes da [VerfasserIn] |
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| Links: |
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| Themen: |
8VZV102JFY |
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| Anmerkungen: |
Date Completed 13.11.2023 Date Revised 15.02.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.mycmed.2023.101434 |
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| funding: |
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| 100 | 1 | |a Silva, Wellington Fernandes da |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Assessing the impact of prophylactic anidulafungin during remission induction of acute myeloid leukemia - A propensity-score matching analysis |
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| 500 | |a Date Revised 15.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 SFMM. Published by Elsevier Masson SAS. All rights reserved. | ||
| 520 | |a INTRODUCTION: Invasive fungal infection (IFI) accounts for substantial morbidity during the treatment of acute myeloid leukemia (AML) in adults. Antifungal prophylaxis (AP) is needed during intensive chemotherapy, and posaconazole is not widely available. In this study, we aimed to examine the impact of prophylactic anidulafungin during intensive AML remission induction | ||
| 520 | |a METHODS: This is a retrospective cohort encompassing newly diagnosed AML adult patients. All subjects received intensive chemotherapy and were divided into three groups: patients who did not receive any AP and patients who received fluconazole (150-400 mg/day) or anidulafungin (100 mg/day) | ||
| 520 | |a RESULTS: During AML induction, 82 patients did not receive AP, 108 and 14 patients received anidulafungin and fluconazole, respectively. IFI incidence was 27%, classified as possible, probable, and proven in 65, 2 and 33%, respectively. Multivariable analysis showed that lower neutrophil counts are associated with IFI (OR = 2.8), whereas age, genetic classification, and lymphocyte counts were not. To examine the impact of anidulafungin in comparison with 'no AP', a propensity score matching analysis was performed. Use of anidulafungin was not related to less IFI during induction, while neutrophil counts remained significant. Patients under prophylactic anidulafungin received less amphotericin B (p < 0.001) but not voriconazole (p = 0.49) | ||
| 520 | |a DISCUSSION: To our knowledge, this is the first study addressing the role of anidulafungin during AML induction. Here, the incidence of mold infections did not decrease with AP, suggesting that in a setting with a high incidence of IFI, broad spectrum AP might be more suitable | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Acute myeloid leukemia | |
| 650 | 4 | |a Anidulafungin | |
| 650 | 4 | |a Antifungal prophylaxis | |
| 650 | 4 | |a Fungal infection | |
| 650 | 4 | |a Intensive chemotherapy | |
| 650 | 4 | |a Remission induction | |
| 650 | 7 | |a Antifungal Agents |2 NLM | |
| 650 | 7 | |a Fluconazole |2 NLM | |
| 650 | 7 | |a 8VZV102JFY |2 NLM | |
| 650 | 7 | |a Anidulafungin |2 NLM | |
| 650 | 7 | |a 9HLM53094I |2 NLM | |
| 700 | 1 | |a Mendes, Fernanda Rodrigues |e verfasserin |4 aut | |
| 700 | 1 | |a Melo, Raphael da Costa Bandeira de |e verfasserin |4 aut | |
| 700 | 1 | |a Velloso, Elvira Deolinda Rodrigues Pereira |e verfasserin |4 aut | |
| 700 | 1 | |a Rocha, Vanderson |e verfasserin |4 aut | |
| 700 | 1 | |a Rego, Eduardo Magalhaes |e verfasserin |4 aut | |
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