MATTIUZZI GN, BLAMBLE D, ESTEY E, KWARI M, CORTES J, GILES F, KANTARJIAN H; Interscience Conference on Antimicrobial Agents and Chemotherapy.
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2000 Sep 17-20; 40: 363.
MD Anderson Cancer Ctr., Univ. of Texas, Houston, TX
BACKGROUND: Suspected/proven fungal infections (FI) remain a major cause of morbidity/mortality in patients (pts) with AML and MDS undergoing induction chemotherapy (IC). FI is the standard antifungal prophylaxis (AP) used at MDACCC for these pts. Objective: Evaluate the efficacy and toxicity of A vs. FI in pts with AML/MDS undergoing IC. Method: Prospective, randomized, open-label comparative study. Inclusion criteria: untreated AML or MDS, age [3] 15 y.o., Zubrod 3, creatinine 2 mg%, Bilirubin 2 mg%. Pts were randomized to receive either F400 mg POBID + I200 mgPOBID or A 3 mg/kg IV 3x/week.RESULTS: Seventy-three pts in A and 67 pts in FI were evaluable. Median age was 63 vs. 57 respectively, p=.01. Study groups were comparable in terms of perf. status, median WBC, early risk for mortality and chemotherapy. Twenty-three percent and 36% of the pts had MDS (A and FI respectively). Overall, 44% completed their AP. Thirty-two percent of the pts on A and 35% pts on FI were changed to antifungal therapy because persistent FUO (p=ns). Only 5/140 pts developed FI. In the A group 1 pt developed cellulitis (T. glabrata, C. tropicalis and fusarium), and 2 pts had candidemia (T. glabrata + C. albicans and Parapsilopsis, respectively). One pt on FI developed A. fumigatus sinusitis, other had C. tropicalis candidemia. Thirty percent of the pts on A developed pneumonia of unknown pathogen (PUP) vs. 25% pts on FI. Increase of creatinine 2.0 mg (23% vs. 3%; p=.00) and increase of bilirubin 2.0 mg (23% vs. 9%; p=.04) occurred more often with A prophylaxis. Other adverse events were similar in frequency and rare. Response to IC and induction mortality rates were similar as were survival rates.CONCLUSIONS: A and FI prophylaxis provide similar efficacy in relation to documented FI, PUP, induction mortality, CR and long term outcome in pts with AML/MDS undergoing IC. A was associated with higher incidence of increased bilirubin and creatinine.KEYWORDS: Antifungal; Leukemia; Prophylaxis
Publication Types:
Keywords:
- AmBisome
- Amphotericin B
- Antifungal Agents
- Antineoplastic Combined Chemotherapy Protocols
- Bone Marrow Transplantation
- Fluconazole
- Humans
- Itraconazole
- Leukemia
- Leukemia, Myeloid, Acute
- Longitudinal Studies
- Mycoses
- Preleukemia
- Remission Induction
- drug therapy
- prevention & control
- surgery
- therapy
- transplantation
Other ID:
UI: 102247338
From Meeting Abstracts