[구연] Hypomethylating agents를 사용 중인 myelodysplastic syndrome과 acute myeloid leukemia 환자에서 침습적 진균 감염에 대한 posaconazole의 예방 효과
2019년 추계학술대회 초록
- Sukmin Hongo, Youree Jung, Sunghwan Kim, Yun Hee Jo, Yoon Sook Cho, Youngil Koha, and Jung Mi Ohb
Department of Pharmacy, Seoul National University Hospital, Department of Internal Medicine,
Seoul National University Hospitala, College of Pharmacy, Seoul National Universityb
- azacitidine, decitabine, antifungal prophylaxis, invasive fungal infections
[Purpose] To assess the effectiveness of posaconazole compared to fluconazole/itraconazole and no antifungal prophylaxis in the prevention of invasive fungal infections (IFI) in acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) patients on hypomethylating agents
[Methods] We retrospectively analyzed the incidence of IFI in AML and MDS patients ≥18 years of age receiving azacitidine and decitabine at a single tertiary institution between January 2016 and September 2019. The diagnosis for IFI was determined based on the 2008 EORTC/MSG definitions. The patients were categorized into three groups; posaconazole, fluconazole or itraconazole, or no fungal prophylaxis. The primary endpoint was incidence of proven, probable, or possible IFI during the 10 week period from the 1st cycle of azacitidine or decitabine. The second endpoints were mortality rate, systemic antifungal treatment usage, and frequency of causative fungal organism.
[Results] Of a total of 371 patients, 120 were categorized as posaconazole, 115 to fluconazole and itraconazole, and 136 to no fungal prophylaxis group. Baseline characteristics including gender distribution (65.8% vs 67.0% vs 61.8% males, respectively), azacitidine usage (34.2% vs 47.8% vs 78.7%, respectively), and MDS diagnosis (62.5% vs 84.3% vs 86.8%, respectively) were collected. Per the interim results, there were 4/120 IFI (3.33%; 1 proven, 1 probable, and 2 possible) in the posaconazole group, 5/115 IFI (4.35%; 1 proven, 1 probable, and 3 possible) in the fluconazole/itraconazole group, and 6/136 IFI (4.41%; 6 possible) in the no fungal prophylaxis group. Complete data results will be presented at the 2019 Korean Society of Health-System Pharmacists Fall Meeting.
[Conclusion] IFI can occur in AML and MDS patients receiving azacitidine and decitabine with or without antifungal prophylaxis. Further analysis is necessary to determine the effectiveness of antifungal prophylaxis in the prevention of IFI.
- A-15. 홍석민(서울대학교병원).pdf