Long-Lasting Protective Effect of Posaconazole Prophylaxis in Patients with Acute Myeloid Leukemia Receiving Allogeneic Hematopoietic Stem Cell Transplantation

Patients with acute myeloid leukaemia (AML) during induction chemotherapy and those who receive allogeneic hematopoietic stem cell transplantation (HSCT) are at higher risk of invasive fungal infections (IFI). In the present study we investigated whether the risk of IFI in AML patients receiving HSCT, might be affected by the antifungal prophylaxis with posaconazole administered during the induction/salvage chemotherapy treatment (ISCT). Between August 2001 and April 2015, 130 patients with AML received itraconazole/fluconazole (group A) and 99 received posaconazole (group B) as antifungal prophylaxis after ISC at 7 Italian Centers while all patients received fluconazole as antifungal prophylaxis after HSCT. Median duration of antifungal prophylaxis after ISCT was significantly longer for patients in group A as compared with group B (24 days vs 20 days, p=0.019). One-year cumulative incidence of proven/probable IFI post-HSCT was 14% and 1% in group A and group B respectively (p=0.012). Fungal free survival and overall survival at 1 year post-HSCT were 66% and 70% in group A, and 75% and 77% in group B (p= 0.139 and p=0.302). Multivariate logistic analysis identified the use of alternative donors (MUD: OR, 3.25; haploidentica/PMRD:OR, 3.19), antifungal prophylaxis with itraconazole/fluconazole (OR, 3.82) and reduced intensity conditionings (OR, 4.92) as independent risk factors for the development of IFI after HSCT. In summary, the present study suggests that the protective effects of posaconazole during ISC for AML patients may have long-lasting benefits and eventually contribute to reduce the risk of IFI when patients undergo allogeneic HSCT