Egerer, G., & Geist, M.J. (2011). Posaconazole prophylaxis in patients with acute myelogenous leukaemia—Results from an observational study. Mycoses, 54(Suppl. 1), 7–11.

200 mg of oral posaconazole was started three times daily on patients on the first day after their chemotherapy ended. Treatment was started prophylactically and was independent of a specific cycle of chemotherapy (i.e., some patients started after cycle 1, some started after cycle 2). A total of 76 chemotherapy cycles were included among these 40 patients.

• Forty participants with an age range of 38–76 years.
• 65% were male, 35% were female
• Key disease characterisitcs included acute myelogenous leukemia (30 of the participating patients), acute myelogenous leukemia after MDS conversion (9 patients), and one patient with chronic myeloid leukemia with biphenotypic blast crisis.

A single site in Heidelberg, Germany.
 

Active treatment

Retrospective, observational study.

• Development of fungal Infection in patients receiving posaconazole as prophylaxis.   
• Development of sepsis in patients receiving posaconazole as prophylaxis.
   

23 patients enrolled in the study developed pneumonia, with 13 being possible invasive fungal disease and 1 being proven aspergillosis. Single-agent posaconazole as prophylaxis was interrupted in 25 of the 40 enrolled patients due to various causes; one patient was unable to swallow due to mucositis, two developed adverse reactions. One third of the patients (25 cycles of the 76 studied) had systemic therapy of different types started during the study time period because of signs and symptoms of fungal infection or due to adverse events.

Based on the findings of the study, posaconzole may show promise for prevention of fungal infection in the immunocompromised patient, although it cannot be relied on as monotherapy for all patients due to the limitations of it being only PO and the use of other systemic anti-fungal prophylaxis. More studies are needed with posaconazole to determine its effectiveness as sole prophylaxis.

Some patients included were receiving additional prophylactic treatment other than posaconazole, making it hard to determine which drug was the most effective in prevention of invasive fungal infection.

Posaconazole may be an effective treatment prophylactically for fungal infection if patients are able to take oral medications, but further studies are needed to determine how effective it can be. The fact that it only comes as an oral product limits the population that may benefit.