scholarly journals Defining standards of CARE for invasive fungal diseases in adult haematology patients: antifungal prophylaxis versus treatment

2019 ◽  
Vol 74 (Supplement_2) ◽  
pp. ii21-ii26 ◽  
Author(s):  
Rosemary Barnes ◽  
Thomas Rogers ◽  
Johan Maertens
Keyword(s):  
Antifungal Prophylaxis ◽  
Fungal Diseases ◽  
Standards Of Care ◽  
Invasive Fungal Diseases ◽  
Haematology Patients ◽  
Versus Treatment

scholarly journals Oral Posaconazole or Intravenous-Oral Itraconazole in Preventing Invasive Fungal Diseases for Patients with Acute Leukemia

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 14-15
Author(s):  
Li Liu ◽  
Xiaolei Pei ◽  
Runzhi Ma ◽  
Yi He ◽  
Rongli Zhang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Acute Leukemia ◽  
Propensity Scores ◽  
Conflicts Of Interest ◽  
Infectious Complications ◽  
Antifungal Prophylaxis ◽  
Fungal Diseases ◽  
Invasive Fungal Diseases ◽  
Significant Difference ◽  
Oral Itraconazole

Background and Objectives: Invasive fungal diseases (IFDs) are major and lethal infectious complications for patients with neutropenia after chemotherapy for acute leukemia (AL). We aimed to compare the use of oral posaconazole vs. itraconazole in an intravenous-oral regimen for primary antifungal prophylaxis in terms of efficacy, adverse events and costs among neutropenic patients with AL after chemotherapy. Methods: This single-center, retrospective study enrolled patients with AL. Prophylaxis with oral posaconazole or intravenous-oral itraconazole (intravenous formulation × 2 days + oral suspension) was administered for patients recovering from neutropenia after chemotherapy. Propensity-score matching was used to assemble a cohort of patients with similar baseline characteristics. Results: Among 342 eligible episodes from 186 patients, 110 episodes received oral posaconazole and 110 episodes received itraconazole in sequential regimen had similar propensity scores and were included in the analyses. The incidence of breakthrough IFDs was 0.0% (0/110) and 0.0% (0/110) in the posaconazole group and itraconazole group, while the incidence of proven, probable and possible IFDs was 1.8% (2/110) and 8.2% (9/110), respectively (P=0.030). In clinical failure analysis, the failure rate of posaconazole group was lower as compared to the itraconazole group (2.7% vs. 10.9%, P=0.016). The proportion of patients who needed systemic antifungal treatment were lower in posaconazole group than that in itraconazole group (2.7% vs. 10.0%, P=0.027). Five cases (4.5%) experienced adverse events possibly associated with posaconazole and thirteen cases (11.8%) with itraconazole (P=0.049). There was no significant difference of survival between patients on posaconazole or itraconazole. The acquisition costs of posaconazole were higher than those of itraconazole (P=0.000). Conclusions: Both oral posaconazole and intravenous-oral itraconazole are effective in preventing IFDs for acute leukemia patients recovering from neutropenia after chemotherapy, while posaconazole is slightly better. Oral posaconazole is safer and more tolerable but costs higher than intravenous-oral itraconazole. Disclosures No relevant conflicts of interest to declare.

scholarly journals Defining standards of CARE for invasive fungal diseases in the ICU

2019 ◽  
Vol 74 (Supplement_2) ◽  
pp. ii9-ii15 ◽  
Author(s):  
Manuel Cuenca-Estrella ◽  
Daniel H Kett ◽  
Joost Wauters
Keyword(s):  
Fungal Infection ◽  
Invasive Fungal Infection ◽  
Patient Population ◽  
Invasive Pulmonary Aspergillosis ◽  
Fungal Diseases ◽  
Diagnosis And Treatment ◽  
Standards Of Care ◽  
Pulmonary Aspergillosis ◽  
Invasive Fungal Diseases ◽  
Neutropenic Patients

Abstract The aim of this article is to review the current recommendations for the diagnosis and treatment of invasive fungal infection in the ICU setting and to explore whether there are standards of care for this patient population. The text focuses mainly on the two most common invasive fungal diseases that afflict non-neutropenic patients: candidaemia and invasive candidosis (IC), and invasive pulmonary aspergillosis (IPA).

scholarly journals 755. Posaconazole versus voriconazole as antifungal prophylaxis for invasive fungal diseases in patients with hematological malignancies

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S425-S425
Author(s):  
Reem F Almutairy ◽  
Mansoor Khan ◽  
Majed Alshamrani ◽  
Hassan Marhabi ◽  
Doaa Naeem
Keyword(s):  
Adverse Events ◽  
Retrospective Chart Review ◽  
Cost Effective ◽  
Antifungal Prophylaxis ◽  
Incidence Rates ◽  
Fungal Diseases ◽  
Comparable Efficacy ◽  
Efficacy And Safety ◽  
International Guidelines ◽  
Invasive Fungal Diseases

Abstract Background The incidence of Invasive Fungal Diseases (IFDs) has dramatically increased in patients with hematologic malignancies due to prolonged neutropenia. IFDs are associated with significant morbidity and mortality. Due to these risks, international guidelines have recommended antifungal prophylaxis for Acute Myeloid Leukemia (AML) and Myelodysplastic syndromes (MDS) patients. Posaconazole has been recommended as the prophylactic agent of choice. Also, voriconazole has been recommended by guidelines with different levels of recommendations. Data on a direct comparison between Posaconazole delayed-release tablets (DR) and Voriconazole for IFD prophylaxis are lacking. Therefore, we aim to compare the efficacy and safety of the fungal prophylaxis; voriconazole versus posaconazole in AML/MDS patients at Princess Nourah Oncology Center, Jeddah Methods Retrospective chart review study for eligible patients from January 2017 to February 2019 to identify the breakthrough IFD rates and assess the frequency of adverse events within AML/MDS patients at PNOC, Saudi Arabia Results A total of 48 patients (130 chemo cycles) were included in the study: 50 using posaconazole (DR) and 80 using oral voriconazole as antifungal prophylaxis. The incidence rates of IFD in the posaconazole group was 8 % (4/50) of those 2 were probable, and 2 were possible infections while 6.26 % (5/80) of patients in the voriconazole group have developed IFD of them 4 had a possible infection, and one had a probable infection (p=0.7325). A higher percentage of patients in the voriconazole group discontinued prophylaxis due to adverse events (5 patients vs. 2 patients). Use of voriconazole as antifungal prophylaxis for 15 days in 130 cycles in 48 AML/MDS patients would cost 175,500 SR in comparison to the cost of the posaconazole for the same duration of 1,350,130 SR. So, use of voriconazole would save 1.13 million SR and is more cost effective when used as antifungal prophylaxis in AML/MDS patients in comparison to posaconazole although later is category 1 recommended antifungal prophylaxis in international guidelines Conclusion Our study has shown that both posaconazole and voriconazole have comparable efficacy and safety in the prevention of IFD in AML and MDS receiving chemotherapy but voriconazole is more cost effective Disclosures All Authors: No reported disclosures

scholarly journals When azoles cannot be used: the clinical effectiveness of intermittent liposomal amphotericin prophylaxis in haematology patients

2021 ◽  
Author(s):  
R Batchelor ◽  
C Thomas ◽  
B J Gardiner ◽  
S J Lee ◽  
S Fleming ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Acute Myeloid Leukaemia ◽  
Myeloid Leukaemia ◽  
Liposomal Amphotericin ◽  
Kidney Injury ◽  
Antifungal Prophylaxis ◽  
High Rate ◽  
Clinical Scenarios ◽  
Haematology Patients ◽  
Acute Myeloid

Abstract Background Patients unable to take azoles are a neglected group lacking a standardized approach to antifungal prophylaxis. We evaluated the effectiveness and safety of intermittent liposomal amphotericin (L-AMB) prophylaxis in a heterogenous group of haematology patients. Methods A retrospective cohort of all haematology patients who received a course of intravenous L-AMB defined as 1mg/kg thrice weekly, from 1 July 2013-30 June 2018 were identified from pharmacy records. Outcomes included breakthrough-invasive fungal disease (BIFD), reasons for premature discontinuation and acute kidney injury. Results There were 198 patients who received 273 courses of L-AMB prophylaxis. Using a conservative definition, the BIFD rate was 9.6% (n=19/198) occurring either during L-AMB prophylaxis or up to 7 days from cessation in patients who received a course. Probable/proven-BIFD occurred in 13 patients (6.6%, 13/198), including molds in 54% (n=7) and non-albicans Candidaemia in 46% (n=6). Cumulative incidence of BIFD was highest in patients with acute myeloid leukaemia (6.8%) followed by acute lymphoblastic leukaemia (2.7%) and allogeneic stem cell transplantation (2.5%). The most common indication for L-AMB was chemotherapy or anticancer drug-azole interactions (75% of courses) dominated by vincristine or acute myeloid leukaemia clinical trials, followed by gut absorption concerns (13%) and liver function abnormalities (8.8%). Acute kidney injury using a modified international definition, complicated 27% of courses but was not clinically significant accounting for only 3.3% (9/273) of discontinuations. Conclusions Our findings demonstrate a high rate of BIFD among patients receiving L-AMB prophylaxis. Pragmatic trials will help find the optimal regimen of L-AMB prophylaxis for the many clinical scenarios where azoles are unsuitable, especially as targeted anticancer drugs increase in use.

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