All content on this site is intended for healthcare professionals only. By acknowledging this message and accessing the information on this website you are confirming that you are a Healthcare Professional. If you are a patient or carer, please visit Know AML.
Introducing
Now you can personalise
your AML Hub experience!
Bookmark content to read later
Select your specific areas of interest
View content recommended for you
Find out moreThe AML Hub website uses a third-party service provided by Google that dynamically translates web content. Translations are machine generated, so may not be an exact or complete translation, and the AML Hub cannot guarantee the accuracy of translated content. The AML Hub and its employees will not be liable for any direct, indirect, or consequential damages (even if foreseeable) resulting from use of the Google Translate feature. For further support with Google Translate, visit Google Translate Help.
Bookmark this article
Allogeneic Hematopoietic Stem Cell Transplantation (allo-HSCT) is considered to be curative treatment in Acute Myeloid Leukemia (AML) patients with high risk of relapse or whom have already relapsed after treatment. However, Invasive Fungal Infections (IFIs) are a major cause of concern for recipients of allo-HSCT. Patients are often treated with immunosuppressant therapy in order to prevent graft rejection and to alleviate graft versus host reactions. Unfortunately, this can result in the patients becoming immunocompromised and vulnerable to systemic infections.
These type of infections are problematic and often lead to increased morbidity and mortality in patients. Since allo-HSCT procedures are frequently used to treat AML, IFIs need to be managed in order to improve the unfavorable outcomes. According to Busca et al., there have been four main approaches to managing fungal infections in immunocompromised patients. These include the following1:
Azoles tend to be the mainstay of IFI therapy in immunocompromised patients. In another recent study, Busca et al. investigated whether the risk of IFI in AML patients receiving allo-HSCT could be reduced through antifungal prophylaxis with posaconazole administered during induction/salvage chemotherapy treatment.
The potential antifungal prophylactic effects of posaconazole was compared to conventional azole therapy in 229 patients.
The authors reported that the 1-year cumulative incidence of proven/probable IFI after allo-HSCT for patients treated with the conventional azole therapy versus posaconazole was 14% and 4%, respectively (P = .012). They concluded that the prophylactic use of posaconazole during induction/salvage chemotherapy may help to reduce the risk of fungal infection post–HSCT, thus potentially improving patient outcomes.
The study was published in Biology of Blood and Marrow Transplant in September 2016.
Please find the published abstract below:
Patients with acute myeloid leukemia (AML) during induction chemotherapy and those who receive allogeneic hematopoietic stem cell transplantation (HSCT) are at higher risk of invasive fungal infections (IFI). In the present study, we investigated whether the risk of IFI in AML patients receiving HSCT might be affected by the antifungal prophylaxis with posaconazole administered during the induction/salvage chemotherapy treatment. Between August 2001 and April 2015, 130 patients with AML received itraconazole/fluconazole (group A) and 99 received posaconazole (group B) as antifungal prophylaxis after induction/salvage chemotherapy at 7 Italian centers and all patients received fluconazole as antifungal prophylaxis after HSCT. The median duration of antifungal prophylaxis after induction/salvage chemotherapy was significantly longer for patients in group A than for those in group B (24 days versus 20 days, P = .019). The 1-year cumulative incidence of proven/probable IFI after HSCT was 14% and 4% in group A and group B, respectively (P = .012). Fungal-free survival and overall survival at 1 year after HSCT were 66% and 70% in group A, and 75% and 77% in group B (P = .139 and P = .302), respectively. Multivariate logistic analysis identified the use of alternative donors (matched unrelated donor: odds ratio [OR], 3.25; haploidentical/partially matched related donor: OR, 3.19), antifungal prophylaxis with itraconazole/fluconazole (OR, 3.82), and reduced-intensity conditioning (OR, 4.92) as independent risk factors for the development of IFI after HSCT. In summary, the present study suggests that the protective effects of posaconazole during induction/salvage chemotherapy for AML patients may have long-lasting benefits and eventually contribute to reduce the risk of IFI when patients undergo allogeneic HSCT.
Your opinion matters
Subscribe to get the best content related to AML delivered to your inbox