Evaluation of Posaconazole for Primary Prophylaxis of IFI in Acute Myeloid Leukemia under Intensive Induction Chemotherapy. Comparative Real Life Study with Fluconazole in two Hematological Centers in Algeri
Introduction: Acute myeloid leukemia (AML) is a hematological malignancy with a poor prognosis. The early consequences of induction chemotherapy are represented by pancytopenia with severe immunosuppression, which favors the emergence of so-called “opportunistic” infections and in particular invasiv...
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| Format: | Article |
| Language: | English |
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West Asia Organization for Cancer Prevention
2021-12-01
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| Series: | Asian Pacific Journal of Cancer Biology |
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| Online Access: | http://www.waocp.com/journal/index.php/apjcb/article/view/680 |
| _version_ | 1797338768274882560 |
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| author | Mohamed Amine Bekadja Mauricette Michallet Brahim Benzineb Naima Mesli Hafida Ouldjeriouat Faiza Serradj Mohamed Brahimi Nabil Yafour |
| author_facet | Mohamed Amine Bekadja Mauricette Michallet Brahim Benzineb Naima Mesli Hafida Ouldjeriouat Faiza Serradj Mohamed Brahimi Nabil Yafour |
| author_sort | Mohamed Amine Bekadja |
| collection | DOAJ |
| description | Introduction: Acute myeloid leukemia (AML) is a hematological malignancy with a poor prognosis. The early consequences of induction chemotherapy are represented by pancytopenia with severe immunosuppression, which favors the emergence of so-called “opportunistic” infections and in particular invasive fungal infections (IFI) such as invasive aspergillosis (IA). This justifies the implementation of early, empirical, pre-emptive or prophylactic antifungal treatment. The objective of this study is the evaluation of a comparative study before and after the use of primary prevention with posaconazole versus fluconazole, in terms of incidence and mortality of invasive fungal infections (IFIs) during AML inductions, in real life in Algeria.
Patients and methods: This study was performed in two periods in the 2 centers concerning the same AML patients receiving the
same induction chemotherapy (daunorubicin 60 mg/m2 for 3 days and cytarabine 100 mg/m2 for 7 days) but with a different type of hospitalization with common rooms for Tlemcen and protected single rooms for Oran. Period 1: The retrospective study was performed from 2014 to 2016 and involved 188 patients. 70 patients were hospitalized in a common room (Tlemcen) and 118 patients in a protected single room (Oran). All patients received as primary IFI prophylaxis fluconazole 400 mg/day. Period 2: The prospective study was conducted from April 2017 to September 2018 and involved 55 patients. Fourteen patients were hospitalized in Tlemcen and 41 patients in an Oran. These patients received posaconazole prophylaxis at a dose of 200 mgx3/day. The evaluation and comparison of descriptive and incidence data was performed using Chi2 statistical tests using SPSS version 19 software. Overall survival (OS) were calculated using the Kaplan-Meier estimate and were compared using the log-rank test with a significance level α of 0.05.
Results: Period 1: The incidence rate of IFI: 34% at the Oran hospital versus 49% at the Tlemcen hospital (p=0.049). Among the 74 patients who presented with IFI, 39 (53%) died from IFI as the main cause of death, among these deaths, 16 (40%) were recorded at Oran and 23 (68%) at Tlemcen (p=0.011). Period 2: The IFI rate with fluconazole was 39% and that observed with posaconazole 22% (p=0.001) and the cumulative incidence was 39% at 21 days versus 10% at 15 days (p=0.046) with a highly significant decrease in IFI-related deaths: 53% versus 25% (p=0.004).
Conclusion: This work has demonstrated the interest in terms of IFI incidence (17% versus 33%, p=0.04) and IFI-related mortality of posaconazole prophylaxis (25% versus 53%, p=0.004) used during AML in the context of hospitalization in common rooms. Furthermore, this work highlights that the combination of posaconazole prophylaxis and hospitalization in a protected single room allows an optimization of the management of this type of patients. |
| first_indexed | 2024-03-08T09:36:04Z |
| format | Article |
| id | doaj.art-a5a4738fa9f7474d9e56a39eb4bdc657 |
| institution | Directory Open Access Journal |
| issn | 2538-4635 |
| language | English |
| last_indexed | 2024-03-08T09:36:04Z |
| publishDate | 2021-12-01 |
| publisher | West Asia Organization for Cancer Prevention |
| record_format | Article |
| series | Asian Pacific Journal of Cancer Biology |
| spelling | doaj.art-a5a4738fa9f7474d9e56a39eb4bdc6572024-01-30T09:10:12ZengWest Asia Organization for Cancer PreventionAsian Pacific Journal of Cancer Biology2538-46352021-12-016424925410.31557/apjcb.2021.6.4.249-254680Evaluation of Posaconazole for Primary Prophylaxis of IFI in Acute Myeloid Leukemia under Intensive Induction Chemotherapy. Comparative Real Life Study with Fluconazole in two Hematological Centers in AlgeriMohamed Amine Bekadja0Mauricette Michallet1Brahim Benzineb2Naima Mesli3Hafida Ouldjeriouat4Faiza Serradj5Mohamed Brahimi6Nabil Yafour7HEMATOLOGY AND CELL THERAPY DEPARTMENT EHU OranDepartment of Hematology, Cancer Center, Léon Bérard, Lyon, France.Department of Hematology, CHU Tlemcen, Algeria.Department of Hematology, CHU Tlemcen, Algeria.HEMATOLOGY AND CELL THERAPY DEPARTMENT EHU OranHEMATOLOGY AND CELL THERAPY DEPARTMENT EHU OranHEMATOLOGY AND CELL THERAPY DEPARTMENT EHU OranHEMATOLOGY AND CELL THERAPY DEPARTMENT EHU OranIntroduction: Acute myeloid leukemia (AML) is a hematological malignancy with a poor prognosis. The early consequences of induction chemotherapy are represented by pancytopenia with severe immunosuppression, which favors the emergence of so-called “opportunistic” infections and in particular invasive fungal infections (IFI) such as invasive aspergillosis (IA). This justifies the implementation of early, empirical, pre-emptive or prophylactic antifungal treatment. The objective of this study is the evaluation of a comparative study before and after the use of primary prevention with posaconazole versus fluconazole, in terms of incidence and mortality of invasive fungal infections (IFIs) during AML inductions, in real life in Algeria. Patients and methods: This study was performed in two periods in the 2 centers concerning the same AML patients receiving the same induction chemotherapy (daunorubicin 60 mg/m2 for 3 days and cytarabine 100 mg/m2 for 7 days) but with a different type of hospitalization with common rooms for Tlemcen and protected single rooms for Oran. Period 1: The retrospective study was performed from 2014 to 2016 and involved 188 patients. 70 patients were hospitalized in a common room (Tlemcen) and 118 patients in a protected single room (Oran). All patients received as primary IFI prophylaxis fluconazole 400 mg/day. Period 2: The prospective study was conducted from April 2017 to September 2018 and involved 55 patients. Fourteen patients were hospitalized in Tlemcen and 41 patients in an Oran. These patients received posaconazole prophylaxis at a dose of 200 mgx3/day. The evaluation and comparison of descriptive and incidence data was performed using Chi2 statistical tests using SPSS version 19 software. Overall survival (OS) were calculated using the Kaplan-Meier estimate and were compared using the log-rank test with a significance level α of 0.05. Results: Period 1: The incidence rate of IFI: 34% at the Oran hospital versus 49% at the Tlemcen hospital (p=0.049). Among the 74 patients who presented with IFI, 39 (53%) died from IFI as the main cause of death, among these deaths, 16 (40%) were recorded at Oran and 23 (68%) at Tlemcen (p=0.011). Period 2: The IFI rate with fluconazole was 39% and that observed with posaconazole 22% (p=0.001) and the cumulative incidence was 39% at 21 days versus 10% at 15 days (p=0.046) with a highly significant decrease in IFI-related deaths: 53% versus 25% (p=0.004). Conclusion: This work has demonstrated the interest in terms of IFI incidence (17% versus 33%, p=0.04) and IFI-related mortality of posaconazole prophylaxis (25% versus 53%, p=0.004) used during AML in the context of hospitalization in common rooms. Furthermore, this work highlights that the combination of posaconazole prophylaxis and hospitalization in a protected single room allows an optimization of the management of this type of patients.http://www.waocp.com/journal/index.php/apjcb/article/view/680aml, invasive fungique infection, posaconazole, prophylaxis |
| spellingShingle | Mohamed Amine Bekadja Mauricette Michallet Brahim Benzineb Naima Mesli Hafida Ouldjeriouat Faiza Serradj Mohamed Brahimi Nabil Yafour Evaluation of Posaconazole for Primary Prophylaxis of IFI in Acute Myeloid Leukemia under Intensive Induction Chemotherapy. Comparative Real Life Study with Fluconazole in two Hematological Centers in Algeri Asian Pacific Journal of Cancer Biology aml, invasive fungique infection, posaconazole, prophylaxis |
| title | Evaluation of Posaconazole for Primary Prophylaxis of IFI in Acute Myeloid Leukemia under Intensive Induction Chemotherapy. Comparative Real Life Study with Fluconazole in two Hematological Centers in Algeri |
| title_full | Evaluation of Posaconazole for Primary Prophylaxis of IFI in Acute Myeloid Leukemia under Intensive Induction Chemotherapy. Comparative Real Life Study with Fluconazole in two Hematological Centers in Algeri |
| title_fullStr | Evaluation of Posaconazole for Primary Prophylaxis of IFI in Acute Myeloid Leukemia under Intensive Induction Chemotherapy. Comparative Real Life Study with Fluconazole in two Hematological Centers in Algeri |
| title_full_unstemmed | Evaluation of Posaconazole for Primary Prophylaxis of IFI in Acute Myeloid Leukemia under Intensive Induction Chemotherapy. Comparative Real Life Study with Fluconazole in two Hematological Centers in Algeri |
| title_short | Evaluation of Posaconazole for Primary Prophylaxis of IFI in Acute Myeloid Leukemia under Intensive Induction Chemotherapy. Comparative Real Life Study with Fluconazole in two Hematological Centers in Algeri |
| title_sort | evaluation of posaconazole for primary prophylaxis of ifi in acute myeloid leukemia under intensive induction chemotherapy comparative real life study with fluconazole in two hematological centers in algeri |
| topic | aml, invasive fungique infection, posaconazole, prophylaxis |
| url | http://www.waocp.com/journal/index.php/apjcb/article/view/680 |
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