Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 28;17(13):2184.
doi: 10.3390/cancers17132184.

Caspofungin for Primary Antifungal Prophylaxis in Acute Myeloid Leukemia: A Real-Life Study from an Academic Center

Francesco Grimaldi  1 , Mara Memoli  1 , Simona Avilia  1 , Carlangela Causa  1 , Maria Luisa Giannattasio  1 , Italia Conversano  1 , Dario Lisi  1 , Daniela D'Angelo  1 , Raffaella Iannotta  1 , Nicola Schiano Moriello  2 , Giulio Viceconte  2 , Emanuela Zappulo  2 , Ivan Gentile  2 , Marco Picardi  1 , Fabrizio Pane  1
Affiliations

Caspofungin for Primary Antifungal Prophylaxis in Acute Myeloid Leukemia: A Real-Life Study from an Academic Center

Francesco Grimaldi et al. Cancers (Basel). .

Abstract

Background: Invasive fungal infections (IFIs) are a major complication in patients with acute myeloid leukemia (AML), particularly during chemotherapy-induced neutropenia. Posaconazole is the standard drug for primary antifungal prophylaxis (PAP), but its use is limited by oral bioavailability and CYP3A4 interactions. Study Objective: This study aims to evaluate the clinical efficacy and safety of intravenous caspofungin versus oral posaconazole as PAP in AML patients during their first cycle of chemotherapy and assess their subsequent impact on clinical outcomes. Methods: A retrospective, monocentric study was conducted on 75 consecutive AML patients treated at the Federico II University Medical School of Naples, Italy (2021-2025). Patients received either caspofungin or posaconazole as PAP based on the drug-drug interaction risk or clinical conditions. IFIs were diagnosed using EORTC/MSG criteria. Logistic and Cox regression models were used to assess risk factors and overall survival (OS). Results: IFI incidence was 13.3% overall (9.4% proven/probable). No significant difference was found between the caspofungin and posaconazole groups (six vs. four IFIs; p = 0.878). Post-chemotherapy refractory AML (OR = 11.9; p = 0.003) and liver disease (OR = 30.4; p = 0.004) independently predicted IFI development. Median OS did not significantly differ in patients receiving caspofungin versus posaconazole (29.3 vs. 32.1 months, p = 0.6). Conclusions: Caspofungin appears clinically comparable to posaconazole for PAP in AML during the induction phase, especially when azole use is contraindicated. Prospective studies are warranted to refine prophylactic strategies in the era of new AML therapies.

Keywords: IFI; acute myeloid leukemia; antifungal prophylaxis; caspofungin; midostaurin; venetoclax.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest in connection with the submitted article.

Figures

Figure 1
Figure 1
IFI and subtype incidence as a percentage of the total population (n = 75).
Figure 2
Figure 2
Correlation matrix showing interactions between covariates and the risk of IFIs.
Figure 3
Figure 3
Forest plot with risk factors for proven or probable IFI.
Figure 4
Figure 4
Kaplan–Meier diagram showing patients’ survival by (a) disease status after induction chemotherapy (refractory disease vs. responding disease) and (b) type of antifungal prophylaxis (posaconazole vs. caspofungin).
See this image and copyright information in PMC

References

    1. Logan C., Koura D., Taplitz R. Updates in infection risk and management in acute leukemia. Hematol. Am. Soc. Hematol. Educ. Program. 2020;2020:135–139. doi: 10.1182/hematology.2020000098. - DOI - PMC - PubMed
    1. Halpern A.B., Lyman G.H., Walsh T.J., Kontoyiannis D.P., Walter R.B. Primary antifungal prophylaxis during curative-intent therapy for acute myeloid leukemia. Blood. 2015;126:2790–2797. doi: 10.1182/blood-2015-07-627323. - DOI - PMC - PubMed
    1. Young J.A.H., Andes D.R., Ardura M.I., Arrieta A., Bow E.J., Chandrasekar P.H., Chen S.C.A., Hammond S.P., Husain S., Koo S., et al. Modeling Invasive Aspergillosis Risk for the Application of Prophylaxis Strategies. Open Forum Infect. Dis. 2024;11:ofae082. doi: 10.1093/ofid/ofae082. - DOI - PMC - PubMed
    1. Rodríguez-Veiga R., Montesinos P., Boluda B., Lorenzo I., Martínez-Cuadrón D., Salavert M., Pemán J., Calvillo P., Cano I., Acuña E., et al. Incidence and outcome of invasive fungal disease after front-line intensive chemotherapy in patients with acute myeloid leukemia: Impact of antifungal prophylaxis. Ann. Hematol. 2019;98:2081–2088. doi: 10.1007/s00277-019-03744-5. - DOI - PubMed
    1. Del Principe M.I., Dragonetti G., Verga L., Candoni A., Marchesi F., Cattaneo C., Delia M., Potenza L., Farina F., Ballanti S., et al. ‘Real-life’ analysis of the role of antifungal prophylaxis in preventing invasive aspergillosis in AML patients undergoing consolidation therapy: Sorveglianza Epidemiologica Infezioni nelle Emopatie (SEIFEM) 2016 study. J. Antimicrob. Chemother. 2019;74:1062–1068. doi: 10.1093/jac/dky550. - DOI - PubMed

LinkOut - more resources