Cho, S.Y., Lee, D.G., Choi, S.M., Choi, J.K., Lee, H.J., Kim, S.H., . . . Min, W.S. (2015). Posaconazole for primary antifungal prophylaxis in patients with acute myeloid leukaemia or myelodysplastic syndrome during remission induction chemotherapy: A single-centre retrospective study in Korea and clinical considerations. Mycoses, 58, 565–571.

DOI Link

Study Purpose

To examine the incidence and outcomes related to the treatment of invasive fungal infection (IFI) with posaconazole versus fluconazole prophylaxis

Intervention Characteristics/Basic Study Process

Records of patients undergoing remission induction chemotherapy were reviewed for data collection. Results of those who received fluconazole versus posaconazole antifungal prophylaxis were compared. Both agents were begun 1–2 days prior to chemotherapy and continued until the patients' absolute neutrophil count (ANC) was > 500/mm3.

Sample Characteristics

  • N = 424
  • MEAN AGE = 45.6 years
  • MALES: 56.1%, FEMALES: 43%
  • CURRENT TREATMENT: Chemotherapy
  • KEY DISEASE CHARACTERISTICS: All had either acute myeloid leukemia (AML) or myelodysplastic syndrome

Setting

  • SITE: Single site
  • SETTING TYPE: Not specified
  • LOCATION: Korea

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment

Study Design

  • Retrospective cohort comparison

Measurement Instruments/Methods

  • Neutropenia defined as ANC < 500/mm3 and severe neutropenia as < 100 500/mm3
  • IFI categorized according to European Organization for Research and Treatment of Cancer (EORTC) criteria
  • Breakthrough IFIs were defined as proven or probable if developed after at least seven days of antifungal prophylaxis.
  • Charlson comorbidity index

Results

The incidence of breakthrough IFIs and the use of empirical antifungal treatment were lower in those who received posaconazole (p < 0.001). Overall, IFI-related mortality was 1.9% in the posaconazole group compared to 12.1% in the fluconazole group (p = 0.028). No difference existed between groups in overall survival.

Conclusions

The findings suggest that posaconazole was more effective than early generation azoles for antifungal prophylaxis in at-risk patients with cancer.

Limitations

  • Risk of bias (no blinding)
  • Risk of bias (no random assignment) 
  • Measurement/methods not well described
  • Length of follow-up for data collection was not described.

Nursing Implications

The findings suggest that newer azoles may be more effective for antifungal prophylaxis in at-risk patients with cancer.