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'Real-life' analysis of the role of antifungal prophylaxis in preventing invasive aspergillosis in AML patients undergoing consolidation therapy: Sorveglianza Epidemiologica Infezioni nelle Emopatie (SEIFEM) 2016 study
- Publication Year :
- 2019
-
Abstract
- Background We evaluated the incidence of proven/probable invasive aspergillosis (IA) and the role of antifungal prophylaxis (AP) in a 'real-life' setting of patients with AML receiving intensive consolidation therapy. Methods Cases of IA, observed during consolidation in adult/paediatric patients with AML between 2011 and 2015, were retrospectively collected in a multicentre Italian study. Results Of 2588 patients, 56 (2.2%) developed IA [43 probable (1.7%) and 13 proven (0.5%)]. IA was diagnosed in 34 of 1137 (2.9%) patients receiving no AP and in 22 of 1451 (1.5%) who were given AP (P = 0.01). Number-needed-to-treat calculation indicates that, on average, 71 patients should have received AP (instead of no AP) for one additional patient to not have IA. Initial antifungal therapy was 'pre-emptive' in 36 (64%) patients and 'targeted' in 20 (36%) patients. A good response to first-line therapy was observed in 26 (46%) patients, mainly those who received AP [16 of 22 (73%) versus 10 of 34 (29%); P = 0.001]. The overall mortality rate and the mortality rate attributable to IA by day 120 were 16% and 9%, respectively. In multivariate analysis, age ≥60 years (OR = 12.46, 95% CI = 1.13-136.73; P = 0.03) and high-dose cytarabine treatment (OR = 10.56, 95% CI = 1.95-116.74; P = 0.04) independently affected outcome. Conclusions In our experience, AP appears to prevent IA from occurring during consolidation. However, although the incidence of IA was low, mortality was not negligible among older patients. Further prospective studies should be carried out particularly in elderly patients treated with high-dose cytarabine to confirm our data and to identify subsets of individuals who may require AP.
- Subjects :
- 0301 basic medicine
Microbiology (medical)
Adult
Male
medicine.medical_specialty
Antifungal Agents
AML, SEIFEM, Invasive Aspergillosis, consolidation therapy, antifumgal prophylaxis, antifungal therapy
030106 microbiology
SEIFEM
antifumgal prophylaxis
Comorbidity
Aspergillosis
03 medical and health sciences
0302 clinical medicine
AML
Risk Factors
Internal medicine
Antineoplastic Combined Chemotherapy Protocols
Medicine
Humans
Pharmacology (medical)
030212 general & internal medicine
Prospective cohort study
Aged
Pharmacology
business.industry
Incidence (epidemiology)
Mortality rate
Consolidation Chemotherapy
Induction Chemotherapy
Middle Aged
medicine.disease
antifungal therapy
Leukemia, Myeloid, Acute
Infectious Diseases
Number needed to treat
Cytarabine
Invasive Aspergillosis
Female
business
consolidation therapy
Settore MED/15 - Malattie del Sangue
Invasive Fungal Infections
medicine.drug
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Accession number :
- edsair.doi.dedup.....e21c38d79566450640a7addff3228885