TABLE 2

Clinical and treatment-associated risk factors for IFI and mortality among AML patients who received voriconazole/posaconazole versus echinocandin primary antifungal prophylaxis

Demographic or clinical characteristicpVoriconazole/posaconazole (n = 42)Echinocandin (n = 38)P
Male, n (%)26 (62)23 (61)0.9
Median age (IQR), yrs66 (38–71)69 (61–77)0.03
Race, white, n (%)33 (79)30 (79)0.97
Admission to the HEPA filter room during FRIC, n (%)10 (24)16 (42)0.10
Underlying conditions,a n (%)
    Lung disease or infectionb11 (26)7 (18)0.41
    Bacterial infectionc9 (21)3 (8)0.12
    Cardiovascular disease or condition15 (36)11 (29)0.52
    Diabetes mellitus or induced hyperglycemiad6 (14)7 (18)0.62
    Renal failuree7 (17)7 (18)0.84
    Abnormal liver testf5 (12)4 (11)>0.99
    Other malignancyg6 (14)8 (21)0.43
Chemotherapy naïve38 (90)35 (92)>0.99
WHO AML classifications,h n (%)
    Therapy-related AML1/41 (2)3/38 (5)0.61
    MDS-related changes15/41 (37)13/38 (34)0.83
    Recurrent genetic abnormalities12/41 (29)8/38 (21)0.4
    Myeloid sarcoma1/41 (2)1/38 (3)>0.99
    Acute leukemia of ambiguous lineage0/41 (0)1/38 (3)0.48
    Not otherwise specified13/41 (32)14/38 (37)0.63
Cytogenetic risk group,i n (%)
    Favorable12 (29)6 (16)0.17
    Intermediate I4 (10)2 (5)0.68
    Intermediate II16 (38)16 (42)0.71
    Adverse10 (24)14 (37)0.20
FRIC protocol, n (%)
    Cytarabine-containing regimen36 (86)23 (61)0.01
    Other regimen6 (14)15 (39)
    Investigational chemotherapyj14 (33)21 (55)0.07
    Clofarabine-containing protocolk10 (24)10 (26)0.80
Overall remission,l n (%)29 (69)16 (42)0.02
Neutropenia (ANC ≤ 500 cells/mm3)
    At start of PAP drug, n (%)21 (50)16 (42)0.48
    Median no. of episodes (IQR)3 (1–4)2 (1–3)0.33
    Median duration (IQR),m days46 (26–61)28 (16–45)0.04
Primary antifungal prophylaxis
    Median no. of days to start PAP after FRIC, (IQR)3 (0–5)1 (0–4)0.04
    Median duration of prophylaxis (IQR),n days86 (45–106)19 (10–88)<0.001
    Prophylaxis periods ≥ 5 days,n n (%)42 (100)35 (92)0.10
Concomitant fluconazole use, n (%)13 (31)19 (50)0.11
Median duration of fluconazole use (days),o IQR11 (5–31)21 (3–89)0.59
  • a At-hospital admission or history.

  • b Lung infection at hospital admission or concomitant to AML history.

  • c At-hospital admission or concomitant to AML history according to patient's treating physician based on clinical, microbiology, and antibiotic prescription data.

  • d Diagnosis of diabetes mellitus or induced hyperglycemia (glucose ≥ 200 mg/dl).

  • e Diagnosis of renal failure or a 50% increase in serum creatinine level.

  • f Diagnosis of liver disease or abnormal liver blood tests (serum alanine aminotransferase and/or aspartate aminotransferase levels > 3.0 × upper limit of normality [ULN] and/or total bilirubin > 1.5 × ULN).

  • g Solid cancers in breast (9 patients), skin (7), prostate (4), parotid (2), thyroid (1), vocal cord (1) and cervix uteri (1); chronic myelomonocytic leukemia (2); acute lymphoblastic leukemia (1); Hodgkin's lymphoma (1); not specified (3 patients).

  • h Data are from Vardiman et al. (20).

  • i Data are from Estey (21).

  • j Eleven investigational chemotherapy protocols.

  • k Three investigational clofarabine-containing protocols in FRIC (see footnote to Table 1).

  • l Overall remission as described by Faderl et al. (9).

  • m Considering all episodes of neutropenia.

  • n Prophylaxis period, prophylaxis with same drug and formulation without discontinuation.

  • o Duration per prophylaxis period.

  • p AML, acute myeloid leukemia; ANC, absolute neutrophil count; FRIC, first remission-induction chemotherapy; HEPA, high-efficiency particulate air; MDS, myelodysplastic syndrome; PAP, primary antifungal prophylaxis; WHO, World Health Organization.