Antifungal Treatment Duration in Hematology Patients With Invasive Mold Infections: A Real-life Update.

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Version: Final published version
License: CC BY 4.0
Serval ID
serval:BIB_DB82840AB3F4
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Antifungal Treatment Duration in Hematology Patients With Invasive Mold Infections: A Real-life Update.
Journal
Open forum infectious diseases
Author(s)
Portillo V., Ragozzino S., Stavropoulou E., El-Khoury C., Bochud P.Y., Lamoth F., Khanna N., Neofytos D.
ISSN
2328-8957 (Print)
ISSN-L
2328-8957
Publication state
Published
Issued date
05/2024
Peer-reviewed
Oui
Volume
11
Number
5
Pages
ofae201
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
Limited data exist on when and how to stop antifungal treatment (AFT) in patients with invasive mold infections (IMIs) who are immunocompromised.
This retrospective multicenter study included adult patients with acute myelogenous leukemia and proven/probable IMI (1 January 2010-31 December 2022) in 3 university hospitals. The primary objective was to describe AFT duration and adaptation. Secondary objectives were to investigate the reasons for AFT adjustments and prolongation.
In total 71 patients with 73 IMIs were identified; 51 (71.8%) had an allogeneic hematopoietic cell transplant. Most infections were invasive aspergillosis (IA; 49/71, 69%), followed by mucormycosis (12, 16.9%) and other (12, 16.9%); there were 2 mixed infections. Median treatment duration was 227 days (IQR, 115.5-348.5). There was no difference in AFT duration between patients with IA and non-IA IMI (P = .85) or by center (P = .92). Treatment was longer in patients with an allogeneic hematopoietic cell transplant vs not (P = .004). Sixteen patients (22.5%) had no therapy modifications. In 55 patients (77.5%), a median 2 changes (IQR, 1-3; range, 1-8) were observed. There were 182 reasons leading to 165 changes, associated with clinical efficacy (82/182, 44.5%), toxicity (47, 25.8%), and logistical reasons (22, 12.1%); no reason was documented in 32 changes (18.8%). AFT was continued beyond days 90 and 180 in 59 (83%) and 39 (54.9%) patients, respectively, mostly due to persistence of immunosuppression.
AFT in patients with acute myelogenous leukemia and IMI is longer than that recommended by guidelines and is frequently associated with treatment adjustments due to variable reasons. More data and better guidance are required to optimize AFT duration and secondary prophylaxis administration according to immunosuppression.
Keywords
acute myelogenous leukemia, antifungal treatment changes, antifungal treatment duration, invasive aspergillosis, invasive mold infections
Pubmed
Open Access
Yes
Create date
21/05/2024 14:15
Last modification date
22/05/2024 7:17
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