In the current AML treatment landscape, when is anti-infection and anti-fungal prophylaxis recommended?

The AML Hub was pleased to speak with Uwe Platzbecker, University of Leipzig Medical Center, Leipzig, DE. We asked, In the current acute myeloid leukemia (AML) treatment landscape, when is anti-infection and anti-fungal prophylaxis recommended?

Platzbecker begins by explaining that while both the symptoms of AML and treatment for AML can cause neutropenia, increasing patients’ susceptibility to bacterial or fungal infections, antibiotic prophylaxis is not normally recommended at this stage. He highlights the lack of randomized clinical trials investigating the use of general antibiotic prophylaxis in these patients, and differentiates this from neutropenic fever when antibiotic therapy is essential.

Platzbecker goes on to discuss antifungal prophylaxis, including a randomized clinical trial that has shown benefit of posaconazole compared with current standard of care, and how posaconazole prophylaxis is therefore recommended during intensive chemotherapy in patients with neutropenia. However, he highlights the cytochrome interactions necessitating dose reductions of venetoclax or ivosidenib when antifungal agents are given, and advises caution when using these combinations.