Antifungal Prophylaxis in AML Patients Receiving Intensive Induction Chemotherapy: A Prospective Observational Study From the Acute Leukaemia French Association (ALFA) Group |
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| Affiliation: | 1. Hematology department, Anticancer Centre Léon Bérard, Lyon, France;2. Hematology Department, Saint Louis Hospital, Paris, France;3. Institut Gustave Roussy, Villejuif, France;4. Hématologie Clinique, Dijon University Hospital, Dijon, France;5. Hematology, CHU Caen, Caen, France;6. Hematology, Limoges university hospital, Limoges, France;7. Hematology, CHRU de Lille, Lille, France;8. Service d''hématologie, Institut Universitaire du Cancer de Toulouse - Oncopole, CHU de Toulouse, Toulouse, France;9. Inserm U1245 and Department of Hematology, Centre Henri Becquerel and Normandie Univ UNIROUEN, Rouen, France;10. Hematology, CHU Bordeaux, Pessac, France;11. Hematology, Hopital Mignot, Le Chesnay, France;12. Department of Hematology, University Hospital, Amiens, France;13. Hematology, Henri Mondor Hospital, Creteil, France;14. Hematology, Military Hospital, Clamart, France;15. Hematology, Institut Paoli-Calmettes, Marseille, France;16. Hematology, Avicenne Hospital, APHP, Bobigny, France;17. Hematology, Centre Antoine Lacassagne, Nice, France;18. Hôpital Universitaire Necker-Enfants Malades, Paris, France;19. Hematology, CHU Angers, Angers, France;20. Hematology, CHU Grenoble, Grenoble, France;21. Hematology, CHU Nancy, Nancy, France;22. ALFA Group, Paris, France;23. Haematology Department 1G, Centre Hospitalier Lyon Sud, Pierre Bénite, France;24. Paris-Diderot University, Paris, France;25. Pneumology department, Saint Louis Hospital, AP-HP, Paris, France;1. Perlmutter Cancer Center, NYU Langone Health, New York, NY;2. Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, United Kingdom;3. The Institute of Cancer Research, London, United Kingdom;4. Indiana University School of Medicine, Indianapolis, IN;5. St James''s University Hospital, Leeds, United Kingdom;6. Department of Hematology, Newcastle University, Newcastle upon Tyne, United Kingdom;7. Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom;1. Research Service, St Louis Veterans Affairs Medical Center, St Louis, MO;2. Division of Oncology, Washington University School of Medicine, St. Louis, MO;3. Division of Hematology, Mayo Clinic, Rochester, MN;4. Division of Oncology, Stanford Cancer Institute, Stanford, CA;5. Department of Medical Oncology, Centre for Lymphoid Cancer, Vancouver, BC, Canada;6. Divisions of Hematology/Oncology, UCLA, Los Angeles, CA;7. Divisions of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE;8. Divisions of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Boston, MA;9. U Mass Memorial Cancer Center, Worcester, MA;10. Divisions of Hematology/Oncology, University of Chicago, Chicago, IL;11. Division of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY;12. Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Kansas City, KS;1. Research Service, St Louis Veterans Affairs Medical Center, St. Louis, MO;2. Division of Oncology, Washington University School of Medicine, St. Louis, MO;3. Division of Hematology, Mayo Clinic, Rochester, MN;4. Division of Oncology, Stanford Cancer Institute, CA;5. Centre for Lymphoid Cancer and Department of Medical Oncology, BC Cancer, Vancouver, BC;6. Divisions of Hematology/Oncology, UCLA, Los Angeles, CA;7. Divisions of Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE;8. Divisions of Hematology/Oncology, Massachusetts General Hospital Cancer Center, Boston, MA;9. U Mass Memorial Cancer Center, Worcester, MA;10. Divisions of Hematology/Oncology, University of Chicago, Chicago, IL;11. Division of Medical Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY;12. Division of Hematologic Malignancies and Cellular Therapeutics, University of Kansas Cancer Center, Kansas City, KS;1. Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand;2. Research Unit in Translational Hematology, Chulalongkorn University, Bangkok, Thailand;3. Department of Medicine, Faculty of Medicine, Mahidol University Ramathibodi hospital, Bangkok, Thailand;4. Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiangmai, Thailand;5. Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand;1. Department of Medicine, Division of Hematology, The University of North Carolina at Chapel Hill, Chapel Hill, NC;2. Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC;3. Department of Medicine, Division of Hematology-Oncology, University of Rochester, Rochester, NY |
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| Abstract: | BackgroundAlthough recommended in patients with acute myeloblastic leukaemia (AML) after induction chemotherapy, real-life use of antifungal prophylaxis (AFP) is different among centres.Materials and MethodsThis 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.ResultsA 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.ConclusionsIn 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. |
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| Keywords: | induction chemotherapy Fungal infection recommendations |
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