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...

Descripción completa

Detalles Bibliográficos
Autores principales: Gangneux, Jean-Pierre, Padoin, Christophe, Michallet, Mauricette, Saillio, Emeline, Kumichel, Alexandra, Peffault de La Tour, Régis, Ceballos, Patrice, Gastinne, Thomas, Pigneux, Arnaud
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