Universität zu Köln

Hahn-Ast, C., Felder, L., Mayer, K., Mueckter, S., Ruhnke, M., Hein, R., Hellmich, M., Schwab, K., Rachow, T., Brossart, P. and von Lilienfeld-Toal, M. (2016). Outcome of empirical or targeted antifungal therapy after antifungal prophylaxis in febrile neutropenia. Ann. Hematol., 95 (6). S. 1001 - 1010. NEW YORK: SPRINGER. ISSN 1432-0584

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Abstract

Azole prophylaxis has been shown to be effective in preventing invasive fungal infections (IFIs) and increasing survival in patients with prolonged neutropenia after myelosuppressive chemotherapy for haematological malignancies. Similarly, empirical antifungal therapy for persistent neutropenic fever has been shown to reduce IFI-related mortality. However, to date, there is little information with regard to the outcome of patients who receive both strategies. Here, we present our retrospective data on three cohorts of patients receiving empirical or targeted antifungal therapy after different antifungal prophylaxis regimens. All records from patients who received myelosuppressive induction chemotherapy for acute myelogenous leukemia (AML) in our centre from 2004-2010 were analysed. From 2004-2006, itraconazole was used as antifungal prophylaxis; for the first 6 months in 2007, local polyenes and from mid-2007 till 2010, posaconazole. Data of 315 courses of chemotherapy in 211 patients were analysed. Antifungal therapy (empirical or targeted, time point and antifungal agent at the physician's discretion) was initiated in 50/174 (29 %), 7/18 (39 %) and 34/123 courses (28 %, p = 0.615) in the itra cohort, the cohort without systemic prophylaxis and the posa cohort, respectively, and was effective in 24/50 (48 %), 5/7 (71 %) and 22/34 courses (65 %, p = 0.221), respectively. IFI occurred in 25/174 (14 %), 4/18 (22 %) and 16/123 (13 %) courses, respectively (p = 0.580). IFI-related survival was not different in the three cohorts. Antifungal treatment in patients with AML who received azole prophylaxis resulted in the expected efficacy-importantly, prior posaconazole prophylaxis did not render subsequent antifungal treatment less effective than prior itraconazole prophylaxis.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Hahn-Ast, C. UNSPECIFIED UNSPECIFIED UNSPECIFIED Felder, L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Mayer, K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Mueckter, S. UNSPECIFIED UNSPECIFIED UNSPECIFIED Ruhnke, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hein, R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hellmich, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schwab, K. UNSPECIFIED UNSPECIFIED UNSPECIFIED Rachow, T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Brossart, P. UNSPECIFIED UNSPECIFIED UNSPECIFIED von Lilienfeld-Toal, M. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-276902
DOI:	10.1007/s00277-016-2630-1
Journal or Publication Title:	Ann. Hematol.
Volume:	95
Number:	6
Page Range:	S. 1001 - 1010
Date:	2016
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1432-0584
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language LIPOSOMAL AMPHOTERICIN-B; ACUTE MYELOID-LEUKEMIA; INVASIVE FUNGAL-INFECTIONS; ACUTE MYELOGENOUS LEUKEMIA; DISEASES-WORKING-PARTY; POSACONAZOLE PROPHYLAXIS; CANCER-PATIENTS; PERSISTENT FEVER; GERMAN-SOCIETY; CHEMOTHERAPY Multiple languages Hematology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/27690