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Objective  Posaconazole prophylaxis during induction chemotherapy for acute myeloid leukaemia ( AML ) and myelodysplastic syndromes ( MDS ) has been shown to significantly decrease the incidence of invasive fungal disease ( IFD ) and increase overall survival in a trial setting, but only small real‐life studies have been published.    Methods  This was a retrospective cohort study including consecutive patients with  AML / MDS  treated with intensive induction chemotherapy; 176 patients received fluconazole prophylaxis 2008–2011 and 107 patients received posaconazole prophylaxis 2011–2013. Only proven and probable  IFD  according to the revised  EORTC / MSG  criteria were included in the analysis.    Results  The two cohorts were well matched without significant differences in patient characteristics. At day 100, patients receiving posaconazole had a significantly lower incidence of total  IFD  (0.9% vs. 10.8%,  P  < 0.01), invasive aspergillosis (0% vs. 5.7%,  P  = 0.02) and invasive candidiasis (0% vs. 4.0%,  P  < 0.05). There was no significant difference in overall survival, neither at day 100 (87% in the posaconazole group vs. 85% in the fluconazole group) nor at end of follow‐up (78% vs. 77%).    Conclusions  Posaconazole prophylaxis decreased the incidence of  IFD  but did not improve short‐term overall survival. Improved treatment efficacy of manifest  IFD  is likely to explain the lack of survival benefit.

european journal of haematology

Decreased invasive fungal disease but no impact on overall survival by posaconazole compared to fluconazole prophylaxis: a retrospective cohort study in patients receiving induction therapy for acute myeloid leukaemia/myelodysplastic syndromes