Cargando…
Outcomes of Antifungal Prophylaxis in High-Risk Haematological Patients (AML under Intensive Chemotherapy): The SAPHIR Prospective Multicentre Study
Antifungal prophylaxis (AFP) is recommended by international guidelines for patients with acute myeloid leukaemia (AML) undergoing induction chemotherapy and allogeneic hematopoietic cell transplantation. Nonetheless, treatment of breakthrough fungal infections remains challenging. This observationa...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712136/ https://www.ncbi.nlm.nih.gov/pubmed/33198192 http://dx.doi.org/10.3390/jof6040281 |
_version_ | 1783618303898419200 |
---|---|
author | Gangneux, Jean-Pierre Padoin, Christophe Michallet, Mauricette Saillio, Emeline Kumichel, Alexandra Peffault de La Tour, Régis Ceballos, Patrice Gastinne, Thomas Pigneux, Arnaud |
author_facet | Gangneux, Jean-Pierre Padoin, Christophe Michallet, Mauricette Saillio, Emeline Kumichel, Alexandra Peffault de La Tour, Régis Ceballos, Patrice Gastinne, Thomas Pigneux, Arnaud |
author_sort | Gangneux, Jean-Pierre |
collection | PubMed |
description | Antifungal prophylaxis (AFP) is recommended by international guidelines for patients with acute myeloid leukaemia (AML) undergoing induction chemotherapy and allogeneic hematopoietic cell transplantation. Nonetheless, treatment of breakthrough fungal infections remains challenging. This observational, prospective, multicentre, non-comparative study of patients undergoing myelosuppressive and intensive chemotherapy for AML who are at high-risk of invasive fungal diseases (IFDs), describes AFP management and outcomes for 404 patients (65.6% newly diagnosed and 73.3% chemotherapy naïve). Ongoing chemotherapy started 1.0 ± 4.5 days before inclusion and represented induction therapy for 79% of participants. In 92.3% of patients, posaconazole was initially prescribed, and 8.2% of all patients underwent at least one treatment change after 17 ± 24 days, mainly due to medical conditions influencing AFP absorption (65%). The mean AFP period was 24 ± 32 days, 66.8% stopped their prophylaxis after the high-risk period and 31.2% switched to a non-prophylactic treatment (2/3 empirical, 1/3 pre-emptive/curative). Overall, 9/404 patients (2.2%) were diagnosed with probable or proven IFDs. During the follow-up, 94.3% showed no signs of infection. Altogether, 20 patients (5%) died, and three deaths (0.7%) were IFD-related. In conclusion, AFP was frequently prescribed and well tolerated by these AML patients, breakthrough infections incidence and IFD mortality were low and very few treatment changes were required. |
format | Online Article Text |
id | pubmed-7712136 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-77121362020-12-04 Outcomes of Antifungal Prophylaxis in High-Risk Haematological Patients (AML under Intensive Chemotherapy): The SAPHIR Prospective Multicentre Study Gangneux, Jean-Pierre Padoin, Christophe Michallet, Mauricette Saillio, Emeline Kumichel, Alexandra Peffault de La Tour, Régis Ceballos, Patrice Gastinne, Thomas Pigneux, Arnaud J Fungi (Basel) Article Antifungal prophylaxis (AFP) is recommended by international guidelines for patients with acute myeloid leukaemia (AML) undergoing induction chemotherapy and allogeneic hematopoietic cell transplantation. Nonetheless, treatment of breakthrough fungal infections remains challenging. This observational, prospective, multicentre, non-comparative study of patients undergoing myelosuppressive and intensive chemotherapy for AML who are at high-risk of invasive fungal diseases (IFDs), describes AFP management and outcomes for 404 patients (65.6% newly diagnosed and 73.3% chemotherapy naïve). Ongoing chemotherapy started 1.0 ± 4.5 days before inclusion and represented induction therapy for 79% of participants. In 92.3% of patients, posaconazole was initially prescribed, and 8.2% of all patients underwent at least one treatment change after 17 ± 24 days, mainly due to medical conditions influencing AFP absorption (65%). The mean AFP period was 24 ± 32 days, 66.8% stopped their prophylaxis after the high-risk period and 31.2% switched to a non-prophylactic treatment (2/3 empirical, 1/3 pre-emptive/curative). Overall, 9/404 patients (2.2%) were diagnosed with probable or proven IFDs. During the follow-up, 94.3% showed no signs of infection. Altogether, 20 patients (5%) died, and three deaths (0.7%) were IFD-related. In conclusion, AFP was frequently prescribed and well tolerated by these AML patients, breakthrough infections incidence and IFD mortality were low and very few treatment changes were required. MDPI 2020-11-12 /pmc/articles/PMC7712136/ /pubmed/33198192 http://dx.doi.org/10.3390/jof6040281 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Gangneux, Jean-Pierre Padoin, Christophe Michallet, Mauricette Saillio, Emeline Kumichel, Alexandra Peffault de La Tour, Régis Ceballos, Patrice Gastinne, Thomas Pigneux, Arnaud Outcomes of Antifungal Prophylaxis in High-Risk Haematological Patients (AML under Intensive Chemotherapy): The SAPHIR Prospective Multicentre Study |
title | Outcomes of Antifungal Prophylaxis in High-Risk Haematological Patients (AML under Intensive Chemotherapy): The SAPHIR Prospective Multicentre Study |
title_full | Outcomes of Antifungal Prophylaxis in High-Risk Haematological Patients (AML under Intensive Chemotherapy): The SAPHIR Prospective Multicentre Study |
title_fullStr | Outcomes of Antifungal Prophylaxis in High-Risk Haematological Patients (AML under Intensive Chemotherapy): The SAPHIR Prospective Multicentre Study |
title_full_unstemmed | Outcomes of Antifungal Prophylaxis in High-Risk Haematological Patients (AML under Intensive Chemotherapy): The SAPHIR Prospective Multicentre Study |
title_short | Outcomes of Antifungal Prophylaxis in High-Risk Haematological Patients (AML under Intensive Chemotherapy): The SAPHIR Prospective Multicentre Study |
title_sort | outcomes of antifungal prophylaxis in high-risk haematological patients (aml under intensive chemotherapy): the saphir prospective multicentre study |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7712136/ https://www.ncbi.nlm.nih.gov/pubmed/33198192 http://dx.doi.org/10.3390/jof6040281 |
work_keys_str_mv | AT gangneuxjeanpierre outcomesofantifungalprophylaxisinhighriskhaematologicalpatientsamlunderintensivechemotherapythesaphirprospectivemulticentrestudy AT padoinchristophe outcomesofantifungalprophylaxisinhighriskhaematologicalpatientsamlunderintensivechemotherapythesaphirprospectivemulticentrestudy AT michalletmauricette outcomesofantifungalprophylaxisinhighriskhaematologicalpatientsamlunderintensivechemotherapythesaphirprospectivemulticentrestudy AT saillioemeline outcomesofantifungalprophylaxisinhighriskhaematologicalpatientsamlunderintensivechemotherapythesaphirprospectivemulticentrestudy AT kumichelalexandra outcomesofantifungalprophylaxisinhighriskhaematologicalpatientsamlunderintensivechemotherapythesaphirprospectivemulticentrestudy AT peffaultdelatourregis outcomesofantifungalprophylaxisinhighriskhaematologicalpatientsamlunderintensivechemotherapythesaphirprospectivemulticentrestudy AT ceballospatrice outcomesofantifungalprophylaxisinhighriskhaematologicalpatientsamlunderintensivechemotherapythesaphirprospectivemulticentrestudy AT gastinnethomas outcomesofantifungalprophylaxisinhighriskhaematologicalpatientsamlunderintensivechemotherapythesaphirprospectivemulticentrestudy AT pigneuxarnaud outcomesofantifungalprophylaxisinhighriskhaematologicalpatientsamlunderintensivechemotherapythesaphirprospectivemulticentrestudy |