Evaluation of the practice of antifungal prophylaxis use in patients with newly diagnosed acute myeloid leukemia: results from the SEIFEM 2010-B registry

Livio Pagano, Morena Caira, Anna Candoni, Franco Aversa, Carlo Castagnola, Cecilia Caramatti, Chiara Cattaneo, Christina Cattaneo, Mario Delia, Maria Rosaria De Paolis, Roberta Di Blasi, Luigi Di Caprio, Rosa Fanci, Maria Grazia Garzia, Bruno Martino, Lorella Melillo, Maria Enza Mitra, Gianpaolo Nadali, Annamaria Nosari, Marco PicardiLeonardo Potenza, Prassede Salutari, Enrico Maria Trecarichi, Mario Tumbarello, Luisa Verga, Nicola Vianelli, Alessandro Busca

Risultato della ricerca: Contributo in rivistaArticolo in rivistapeer review


BACKGROUND: To analyze the efficacy of antifungal prophylaxis (AFP) with posaconazole and itraconazole in a real-life setting of patients with acute myeloid leukemia (AML) during the first induction of remission. METHODS: From January 2010 to June 2011, all patients with newly diagnosed AML were consecutively registered and prospectively monitored at 30 Italian hematological centers. Our analysis focused on adult patients who received intensive chemotherapy and a mold-active AFP for at least 5 days. To determine the efficacy of prophylaxis, invasive fungal disease (IFD) incidence, IFD-attributable mortality, and overall survival were evaluated. RESULTS: In total, 515 patients were included in the present analysis. Posaconazole was the most frequently prescribed drug (260 patients [50%]) followed by fluconazole (148 [29%]) and itraconazole (93 [18%]). When comparing the groups taking posaconazole and itraconazole, there were no significant differences in the baseline clinical characteristics, whereas there were significant differences in the percentage of breakthrough IFDs (18.9% with posaconazole and 38.7% with itraconazole, P< .001). The same trend was observed when only proven/probable mold infections were considered (posaconazole, 2.7% vs itraconazole, 10.7%, P= .02). There were no significant differences in the IFD-associated mortality rate, while posaconazole prophylaxis had a significant impact on overall survival at day 90 (P= .002). CONCLUSIONS: During the last years, the use of posaconazole prophylaxis in high-risk patients has significantly increased. Although our study was not randomized, it demonstrates in a real-life setting that posaconazole prophylaxis confers an advantage in terms of both breakthrough IFDs and overall survival compared to itraconazole prophylaxis. Clinical Trials Registration: NCT01315925
Lingua originaleEnglish
pagine (da-a)1515-1521
Numero di pagine7
RivistaClinical Infectious Diseases
Stato di pubblicazionePubblicato - 2012


  • SEIFEM 2010-B registry
  • acute myeloid leukemia
  • antifungal prophylaxis
  • invasive fungal disease


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