Schrenk, K.G., Schnetzke, U., Stegemann, K., von Lilienfeld-Toal, M., Hochhaus, A., & Scholl, S. (2015). Efficacy of antifungal prophylaxis with oral suspension posaconazole during induction chemotherapy of acute myeloid leukemia. Journal of Cancer Research and Clinical Oncology, 141, 1661–1668.
To examine effectiveness of oral suspension posaconazole for antifungal prophylaxis
Consecutive patients were examined retrospectively. All received intensive-induction chemotherapy. All were given oral suspension posaconazole at 200 mg three times daily. All received antibacterial and antiviral prophylaxis. All infectious workups, empiric treatment, and second-line treatment were standard.
Seventy percent did not develop invasive fungal infection during AML induction chemotherapy. Twenty-one percent had possible infection, and one-third underwent empiric first-line antifungal treatment because of persistent fever of unknown origin or presence of pulmonary infiltrates. Fourteen patients with possible infection received either liposomal amphotericin B or caspofungin. Only those receiving caspofungin required second-line antifungal treatment.
A high proportion of patients received consecutive antifungal treatment. Optimal protection against fungal infection in patients with AML undergoing induction chemotherapy is not clear.
Prevention of infection, and invasive fungal infection in particular, is a challenge in patients undergoing induction chemotherapy for AML. Findings from this retrospective review suggest that a high proportion of patients routinely given oral suspension posaconazole required additional treatment for possible invasive fungal infection. The authors noted that there is uncertain bioavailability of posaconazole given as oral suspension, suggesting that evaluation of various formulations is needed, and that this may not be the most effective approach for antifungal prophylaxis.