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. 2025 Jan;41(1):75-88.
doi: 10.1007/s12288-024-01790-2. Epub 2024 May 20.

Antifungal Prophylaxis and Treatment of Breakthrough Invasive Fungal Diseases in High-Risk Hematology Patients: A Prospective Observational Multicenter Study

Gökhan Metan  1 , Ayşe Çiftçioğlu  2 , Rabin Saba  3   4 , Ayşegül Ulu Kılıç  5 , Kevser Özdemir  6   7 , Yasemin Çağ  8 , Demet Kiper Ünal  9   10 , Firdevs Aksoy  11 , Hande Berk  12 , Gürkan Mert  13   14 , Özlem Güzel Tunçcan  15 , Anıl Tombak  16 , İlker İnanç Balkan  17 , Sema Alp Çavuş  18 , Bahar Kandemir  19 , Birsen Mutlu  20 , Ahmet Çağkan İnkaya  1 , Leylagül Kaynar  21   22 , Memiş Hilmi Atay  23 , Fadime Ersoy Dursun  24   25 , Güray Saydam  9 , Yakup Ünsal  26 , Simge Fidan Sarı  20 , Hamdi Akan  2   27 ; Study group
Collaborators, Affiliations

Antifungal Prophylaxis and Treatment of Breakthrough Invasive Fungal Diseases in High-Risk Hematology Patients: A Prospective Observational Multicenter Study

Gökhan Metan et al. Indian J Hematol Blood Transfus. 2025 Jan.

Abstract

We aimed to investigate the approaches for antifungal prophylaxis (AFP) and antifungal treatment in breakthrough invasive fungal diseases (IFDs) under AFP in high-risk hematology patients. Patients ≥ 18-years who received chemotherapy for acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL) or a conditioning regimen for allogeneic hematopoietic stem cell transplantation (AHSCT) with a duration of neutropenia (< 500 cells/mm3) ≥ 10 days were included in a prospective multicenter observational study. Patients were followed until one week after recovery from neutropenia, discharge from the hospital, or death, which comes first to define the success of AFP. A total of 230 patients were recruited from 18 centers in seven months. Posaconazole prophylaxis was used in 134 (44 of whom failed) and 96 patients received fluconazole (28 of whom failed). The survival rate at 12 weeks after the initiation of AFP was higher in patients with successful prophylaxis (96.2% vs 56.9%, p < 0.001). IFDs were diagnosed in 27 patients. Duration of neutropenia was the only risk factor (OR: 1.03; 95% CI: 1.004-1.053) for development of IFDs. The types of breakthrough IFDs were; possible IFD in 15 patients, probable invasive aspergillosis (IA) in 9 patients, proven IA in 2 patients; and proven mucormycosis in 1 patient. Voriconazole was the drug of choice in 16 patients (5 of whom failed). Liposomal amphotericin B was used in the treatment of 8 patients (4 of whom failed). Posaconazole was the most frequently prescribed AFP in AML patients with high compliance to international guidelines. Approximately, one-third of ALL patients and AHSCT recipients received off-label posaconazole prophylaxis.

Keywords: Acute leukemia; Antifungal prophylaxis; Antifungal treatment; Breakthrough invasive fungal diseases; Fluconazole; Posaconazole; Stem cell transplantation.

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Conflict of interest statement

Conflict of InterestGökhan Metan has received honoraria for speaking at symposia and lectures organized by Gilead; Merck, Sharp, and Dohme (MSD); and Pfizer. He has received travel grants from MSD, Pfizer, and Gilead to participate in conferences. Leylagül Kaynar has received honoraria for speaking at symposia and lectures organized by Gilead; Merck, Sharp, and Dohme (MSD); and Pfizer. She has received travel grants from MSD, Pfizer, and Gilead to participate in conferences. All other authors report no conflicts of interest relevant to this article.

References

    1. Maertens JA, Girmenia C, Brüggemann RJ, European Conference on Infections in Leukaemia (ECIL), a joint venture of the European Group for Blood and Marrow Transplantation (EBMT), the European Organization for Research and Treatment of Cancer (EORTC), the Immunocompromised Host Society (ICHS) and; European Conference on Infections in Leukaemia (ECIL), a joint venture of the European Group for Blood and Marrow Transplantation (EBMT), the European Organization for Research and Treatment of Cancer (EORTC), the Immunocompromised Host Society (ICHS) and the European LeukemiaNet (ELN) et al (2018) European guidelines for primary antifungal prophylaxis in adult haematology patients: summary of the updated recommendations from the European Conference on Infections in Leukaemia. J Antimicrob Chemother 73(12):3221–3230 - PubMed
    1. Mariette C, Tavernier E, Hocquet D et al (2017) Epidemiology of invasive fungal infections during induction therapy in adults with acute lymphoblastic leukemia: a GRAALL-2005 study. Leuk Lymphoma 58(3):586–593 - PubMed
    1. Koehler P, Hamprecht A, Bader O et al (2017) Epidemiology of invasive aspergillosis and azole resistance in patients with acute leukaemia: the SEPIA Study. Int J Antimicrob Agents 49:218–223 - PubMed
    1. Cornely OA, Leguay T, Maertens J et al (2017) Randomized comparison of liposomal amphotericin B versus placebo to prevent invasive mycoses in acute lymphoblastic leukaemia. J Antimicrob Chemother 72:2359–2367 - PMC - PubMed
    1. Hilmioğlu-Polat S, Seyedmousavi S, Ilkit M et al (2019) Estimated burden of serious human fungal diseases in Turkey. Mycoses 62(1):22–31 - PubMed