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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
Author(s) -
Dahlén Torsten,
Kalin Mats,
Cederlund Kerstin,
Nordlander Anna,
Björkholm Magnus,
Ljungman Per,
Blennow Ola
Publication year - 2016
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.12565
Subject(s) - posaconazole , medicine , incidence (geometry) , fluconazole , retrospective cohort study , aspergillosis , myelodysplastic syndromes , cohort , induction chemotherapy , cumulative incidence , surgery , chemotherapy , immunology , voriconazole , antifungal , dermatology , bone marrow , physics , optics
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.

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