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EFFECTIVENESS OF PRIMARY ANTI-ASPERGILLUS PROPHYLAXIS DURING REMISSION INDUCTION CHEMOTHERAPY OF ACUTE MYELOID LEUKEMIA
Author
Affilliation
University of Texas MD Anderson Cancer Center. Department of Infectious Diseases, Infection Control and Employee Health. Texas, USA / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Infecção Hospitalar. Rio de Janeiro, RJ, Brasil.
University of Texas MD Anderson Cancer Center. Department of Infectious Diseases, Infection Control and Employee Health. Texas, USA.
University of Texas MD Anderson Cancer Center. Department of Infectious Diseases, Infection Control and Employee Health. Texas, USA.
University of Texas MD Anderson Cancer Center. Department of Infectious Diseases, Infection Control and Employee Health. Texas, USA.
University of Texas MD Anderson Cancer Center. Department of Infectious Diseases, Infection Control and Employee Health. Texas, USA .
University of Texas MD Anderson Cancer Center. Department of Infectious Diseases, Infection Control and Employee Health. Texas, USA.
University of Texas MD Anderson Cancer Center. Department of Infectious Diseases, Infection Control and Employee Health. Texas, USA.
University of Texas MD Anderson Cancer Center. Department of Infectious Diseases, Infection Control and Employee Health. Texas, USA.
University of Texas MD Anderson Cancer Center. Department of Infectious Diseases, Infection Control and Employee Health. Texas, USA .
Abstract
Although antifungal prophylaxis is frequently administered to patients with acute myeloid leukemia (AML) during remissioninduction
chemotherapy (RIC), its impact on reducing invasive fungal infections (IFIs) outside clinical trials is rarely reported.
We performed a retrospective observational study to identify risk factors for development of IFIs (definite or probable, using
revised European Organization for Research and Treatment of Cancer [EORTC] criteria) and all-cause mortality in a cohort of
152 AML patients receiving RIC (2009 to 2011). We also compared rates of IFI and mortality in patients who received echinocandin
versus anti-Aspergillus azole (voriconazole or posaconazole) prophylaxis during the first 120 days of RIC. In multivariate
analysis, clofarabine-based RIC (hazard ratio [HR], 3.5; 95% confidence interval [CI], 1.5 to 8.3; P 0.004) and echinocandin
prophylaxis (HR, 4.6; 95% CI, 1.8 to 11.9; P 0.002) were independently associated with higher rates of IFI rates during RIC.
Subsequent analysis failed to identify any malignancy- or chemotherapy-related covariates linked to echinocandin prophylaxis
that accounted for the higher rates of breakthrough IFI. Although the possibility of other confounding variables cannot be excluded,
our findings suggest that echinocandin-based prophylaxis during RIC for AML may be associated with a higher risk of
breakthrough IFI.
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