The effectiveness of fluconazole, itraconazole solution, voriconazole and posaconazole prophylaxis used consecutive- ly from December 1998 to January 2010 ...
Articles and Brief Reports
Infectious Complications in Hematology
Comparative clinical effectiveness of prophylactic voriconazole/posaconazole to fluconazole/itraconazole in patients with acute myeloid leukemia/myelodysplastic syndrome undergoing cytotoxic chemotherapy over a 12-year period Michelle R. Ananda-Rajah,1 Andrew Grigg,2 Maria T. Downey,3 Ashish Bajel,2 Tim Spelman, 4,5,Allen Cheng,1,6 Karin T. Thursky,7,8 Janette Vincent,9 and Monica A. Slavin7,8 1 Infectious Diseases Unit, Alfred Health, Melbourne, Victoria; 2Hematology & Bone Marrow Transplant Service, Royal Melbourne Hospital, Melbourne, Victoria; 3Pharmacy Department, Royal Melbourne Hospital, Melbourne, Victoria; 4Centre for Population Health, Burnet Institute, Melbourne, Victoria; 5School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria; 6Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria; 7Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria; 8Infectious Diseases Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria; and 9Radiology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
ABSTRACT Post-induction aplasia for acute myeloid leukemia/myelodysplastic syndrome is a high-risk period for invasive fungal diseases. The effectiveness of fluconazole, itraconazole solution, voriconazole and posaconazole prophylaxis used consecutively from December 1998 to January 2010 in patients with acute myeloid leukemia/ myelodysplastic syndrome undergoing remission-induction chemotherapy was retrospectively evaluated. A total of 216 consecutive patients received 573 prophylaxis courses. Breakthrough-invasive fungal disease incidence in fluconazole, itraconazole, voriconazole, posaconazole recipients was 25%, 16%, 14% and 3%, respectively. Voriconazole/posconazole versus fluconazole/itraconazole combined was associated with significant reductions in breakthrough-invasive fungal disease incidence (20% vs. 8%, P=0.011), premature discontinuations (46% vs. 22% P
