TY - JOUR
T1 - Antifungal Prophylaxis in AML Patients Receiving Intensive Induction Chemotherapy
T2 - A Prospective Observational Study From the Acute Leukaemia French Association (ALFA) Group
AU - Michallet, Mauricette
AU - Sobh, Mohamad
AU - Morisset, Stephane
AU - Deloire, Alexandre
AU - Raffoux, Emmanuel
AU - de Botton, Stephane
AU - Caillot, Denis
AU - Chantepie, Sylvain
AU - Girault, Stephane
AU - Berthon, Celine
AU - Bertoli, Sarah
AU - Lepretre, Stephane
AU - Leguay, Thibaut
AU - Castaigne, Sylvie
AU - Marolleau, Jean Pierre
AU - Pautas, Cecile
AU - Malfuson, Jean Valere
AU - Veyn, Norbert
AU - Braun, Thorsten
AU - Gastaud, Lauris
AU - Suarez, Felipe
AU - Schmidt, Aline
AU - Gressin, Remy
AU - Bonmati, Caroline
AU - Celli-Lebras, Karine
AU - El-Hamri, Mohamed
AU - Ribaud, Patricia
AU - Dombret, Herve
AU - Thomas, Xavier
AU - Bergeron, Anne
N1 - Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2022/5/1
Y1 - 2022/5/1
N2 - Background: Although recommended in patients with acute myeloblastic leukaemia (AML) after induction chemotherapy, real-life use of antifungal prophylaxis (AFP) is different among centres. Materials and Methods: This is an ancillary study to a randomized trial on intensive induction chemotherapy in AML patients (ALFA-0702/NCT00932412), where AFP with posaconazole was recommended. IFIs were graded by investigators and by central reviewers according to the revised EORTC definitions. Experts conclusions were compared to the investigators’ ones. Results: A total of 677 patients were included. Four AFP strategies were reported: Group-1: no AFP (n = 203, 30%), Group-2: posaconazole (n = 241, 36%), Group-3: posaconazole with other AFP (n = 142, 21%), Group-4: other AFP (n = 91, 13%). Experts graded more IFI than investigators: proven/probable IFI, 9.0% (n = 61) versus 6.2% (n = 42). The cumulative incidence at day60 of probable/proven IFI was 13.9% (Group-1); 7.9% (Group-2); 5.6% (Group-3); and 6.6% (Group-4). IFI onset was 26 (19-31) days after induction in Groups 2-3, versus 16 (9-25) days in Group 1 and 20 (12-24) days in Group 4 (P<.001). After a median follow-up of 27.5 months (0.4-73.4), the mortality rate was 38.3%, with 5.4% attributed to IFI. In multivariate analysis, IFI occurrence was an independent risk of death (HR5.63, 95%-CI 2.62-12.08, P<.001). EORTC recommendations were applied in only 57% of patients. In patients without IFI, the rate of AML complete remission was higher. Conclusions: In AML patients, AFP delayed the onset of IFI in addition of decreasing their rate. The frequent misidentification of IFI impacts their appropriate management according to recommendations. hematological remission was more frequent in patients without IFI.
AB - Background: Although recommended in patients with acute myeloblastic leukaemia (AML) after induction chemotherapy, real-life use of antifungal prophylaxis (AFP) is different among centres. Materials and Methods: This is an ancillary study to a randomized trial on intensive induction chemotherapy in AML patients (ALFA-0702/NCT00932412), where AFP with posaconazole was recommended. IFIs were graded by investigators and by central reviewers according to the revised EORTC definitions. Experts conclusions were compared to the investigators’ ones. Results: A total of 677 patients were included. Four AFP strategies were reported: Group-1: no AFP (n = 203, 30%), Group-2: posaconazole (n = 241, 36%), Group-3: posaconazole with other AFP (n = 142, 21%), Group-4: other AFP (n = 91, 13%). Experts graded more IFI than investigators: proven/probable IFI, 9.0% (n = 61) versus 6.2% (n = 42). The cumulative incidence at day60 of probable/proven IFI was 13.9% (Group-1); 7.9% (Group-2); 5.6% (Group-3); and 6.6% (Group-4). IFI onset was 26 (19-31) days after induction in Groups 2-3, versus 16 (9-25) days in Group 1 and 20 (12-24) days in Group 4 (P<.001). After a median follow-up of 27.5 months (0.4-73.4), the mortality rate was 38.3%, with 5.4% attributed to IFI. In multivariate analysis, IFI occurrence was an independent risk of death (HR5.63, 95%-CI 2.62-12.08, P<.001). EORTC recommendations were applied in only 57% of patients. In patients without IFI, the rate of AML complete remission was higher. Conclusions: In AML patients, AFP delayed the onset of IFI in addition of decreasing their rate. The frequent misidentification of IFI impacts their appropriate management according to recommendations. hematological remission was more frequent in patients without IFI.
KW - Acute myeloid leukemia
KW - Antifungal prophylaxis
KW - Fungal infection
KW - induction chemotherapy
KW - recommendations
UR - http://www.scopus.com/inward/record.url?scp=85122933994&partnerID=8YFLogxK
U2 - 10.1016/j.clml.2021.10.011
DO - 10.1016/j.clml.2021.10.011
M3 - Article
C2 - 34895843
AN - SCOPUS:85122933994
SN - 2152-2650
VL - 22
SP - 311
EP - 318
JO - Clinical Lymphoma, Myeloma and Leukemia
JF - Clinical Lymphoma, Myeloma and Leukemia
IS - 5
ER -