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Real-world effectiveness of antifungal prophylaxis with posaconazole as the primary agent in patients with haematological malignancies.

Publication ,  Journal Article
Strand, AM; Alexander, BD; Sarpong, E; Wong, JR; Engemann, A; Rizzieri, D; Wu, Y; Johnson, MD
Published in: Mycoses
November 2022

BACKGROUND AND OBJECTIVES: Patients undergoing induction/reinduction chemotherapy for haematologic malignancies (HM) are at risk for invasive fungal infections (IFIs). In 2015, Duke University Hospital (DUH) implemented a new standardised fungal prophylaxis protocol for adult patients undergoing induction chemotherapy for acute lymphocytic leukaemia, acute myelocytic leukaemia and myelodysplastic syndrome. This study assessed the impact of protocol implementation on (1) use of antifungal prophylaxis, throughout the at-risk period and (2) patient outcomes such as IFI and mortality. METHODS: Retrospective, observational study of adult HM patients admitted to DUH for induction/reinduction chemotherapy pre- (7/1/2013-12/31/2014) and post- (1/1/2015-10/31/2016) implementation of standardised antifungal prophylaxis protocol (which recommended posaconazole as the first-line agent). Patients were followed for up to 100 days after initiation of induction chemotherapy to evaluate use of antifungal prophylaxis and patient outcomes. RESULTS: 218 patients with haematologic malignancies were included (90 pre, 128 post). Use of antifungal prophylaxis increased from 81.1% (pre) to 97.7% (post) (p < .0001). Overall, 71% received posaconazole as initial antifungal prophylaxis (64.4% pre, 75.7% post). Approximately one-fourth of patients (25.6%, pre vs 26.6%, post) developed an IFI (proven/probable or possible using modified EORTC definitions) (p = .868); 100-day mortality remained stable (18.9% pre vs 18.8% post, respectively, p = .979). Lack of antifungal prophylaxis and older age (≥60 years) were associated with higher risk of IFI. CONCLUSION: Implementation of a standardised protocol with posaconazole as the primary agent was associated with increased use of antifungal prophylaxis among patients undergoing induction/reinduction chemotherapy for haematologic malignancies in our hospital. Lack of antifungal prophylaxis was an independent predictor of IFIs, underscoring the importance of prophylaxis in this at-risk population.

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Published In

Mycoses

DOI

EISSN

1439-0507

Publication Date

November 2022

Volume

65

Issue

11

Start / End Page

1050 / 1060

Location

Germany

Related Subject Headings

  • Triazoles
  • Retrospective Studies
  • Microbiology
  • Leukemia, Myeloid, Acute
  • Humans
  • Hematologic Neoplasms
  • Antifungal Agents
  • Adult
  • 3202 Clinical sciences
  • 1103 Clinical Sciences
 

Citation

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Strand, A. M., Alexander, B. D., Sarpong, E., Wong, J. R., Engemann, A., Rizzieri, D., … Johnson, M. D. (2022). Real-world effectiveness of antifungal prophylaxis with posaconazole as the primary agent in patients with haematological malignancies. Mycoses, 65(11), 1050–1060. https://doi.org/10.1111/myc.13495
Strand, Andrew M., Barbara D. Alexander, Eric Sarpong, Jessica Retuerto Wong, Ashley Engemann, David Rizzieri, Yuan Wu, and Melissa D. Johnson. “Real-world effectiveness of antifungal prophylaxis with posaconazole as the primary agent in patients with haematological malignancies.Mycoses 65, no. 11 (November 2022): 1050–60. https://doi.org/10.1111/myc.13495.
Strand AM, Alexander BD, Sarpong E, Wong JR, Engemann A, Rizzieri D, et al. Real-world effectiveness of antifungal prophylaxis with posaconazole as the primary agent in patients with haematological malignancies. Mycoses. 2022 Nov;65(11):1050–60.
Strand, Andrew M., et al. “Real-world effectiveness of antifungal prophylaxis with posaconazole as the primary agent in patients with haematological malignancies.Mycoses, vol. 65, no. 11, Nov. 2022, pp. 1050–60. Pubmed, doi:10.1111/myc.13495.
Strand AM, Alexander BD, Sarpong E, Wong JR, Engemann A, Rizzieri D, Wu Y, Johnson MD. Real-world effectiveness of antifungal prophylaxis with posaconazole as the primary agent in patients with haematological malignancies. Mycoses. 2022 Nov;65(11):1050–1060.
Journal cover image

Published In

Mycoses

DOI

EISSN

1439-0507

Publication Date

November 2022

Volume

65

Issue

11

Start / End Page

1050 / 1060

Location

Germany

Related Subject Headings

  • Triazoles
  • Retrospective Studies
  • Microbiology
  • Leukemia, Myeloid, Acute
  • Humans
  • Hematologic Neoplasms
  • Antifungal Agents
  • Adult
  • 3202 Clinical sciences
  • 1103 Clinical Sciences