Tan N Doan1, Carl M J Kirkpatrick1, Patricia Walker2, Monica A Slavin3, Michelle R Ananda-Rajah4, C Orla Morrissey5, Karen F Urbancic6, Andrew Grigg7, Andrew Spencer8, Jeffrey Szer9, John F Seymour10, David C M Kong11. 1. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia. 2. Malignant Haematology and Stem Cell Transplantation Service, Alfred Health, Melbourne, Victoria, Australia. 3. Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia University of Melbourne, Melbourne, Victoria, Australia. 4. General Medicine Unit, Alfred Health, Melbourne, Victoria, Australia Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia. 5. Malignant Haematology and Stem Cell Transplantation Service, Alfred Health, Melbourne, Victoria, Australia Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia Department of Haematology, Monash University, Melbourne, Victoria, Australia. 6. Pharmacy Department, Austin Health, Melbourne, Victoria, Australia Infectious Diseases Department, Austin Health, Melbourne, Victoria, Australia. 7. University of Melbourne, Melbourne, Victoria, Australia Department of Clinical Haematology, Austin Health, Melbourne, Victoria, Australia. 8. Malignant Haematology and Stem Cell Transplantation Service, Alfred Health, Melbourne, Victoria, Australia Department of Haematology, Monash University, Melbourne, Victoria, Australia. 9. University of Melbourne, Melbourne, Victoria, Australia Department of Clinical Haematology and Bone Marrow Transplant Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia. 10. University of Melbourne, Melbourne, Victoria, Australia Department of Haematology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia. 11. Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia david.kong@monash.edu.
Abstract
OBJECTIVES: The primary objectives were to investigate the prescribing practices of primary antifungal prophylaxis (PAP) and incidence of invasive fungal disease (IFD) in adult patients with ALL receiving induction-consolidation chemotherapy. Secondary objectives were to determine risk factors for IFD and resource utilization associated with IFD. METHODS: A retrospective chart review of adult patients with ALL from commencement of induction until completion of consolidation chemotherapy was undertaken from January 2008 to June 2013 in four hospitals in Melbourne, Australia. IFD was classified according to the revised European Organisation for Research and Treatment of Cancer criteria. Cost analysis was performed from an Australian public hospital perspective. RESULTS: Ninety-eight patients were included in the audit; 83 (85%) received PAP. Most patients (49/83, 59%) switched between two different antifungal agents, predominantly between liposomal amphotericin B and an azole. Five proven/probable and six possible IFD cases were identified. Proven/probable IFD was most common in patients receiving the BFM95 chemotherapy protocol. The incidence of proven/probable IFD was significantly lower in patients receiving PAP compared with those who did not (2/78, 2.6% versus 3/14, 21.4%; P = 0.024). For every five patients receiving PAP, one proven/probable IFD case would be prevented. Proven/probable IFD was associated with an additional median cost of 121,520 Australian dollars (95% CI: 90,781-180,141 Australian dollars; P < 0.001) compared with patients without IFD. CONCLUSIONS: This is the first multicentre study evaluating PAP use in patients with ALL. With the caveats of interpretation of retrospective, non-randomized data, PAP was associated with a reduced IFD risk.
OBJECTIVES: The primary objectives were to investigate the prescribing practices of primary antifungal prophylaxis (PAP) and incidence of invasive fungal disease (IFD) in adult patients with ALL receiving induction-consolidation chemotherapy. Secondary objectives were to determine risk factors for IFD and resource utilization associated with IFD. METHODS: A retrospective chart review of adult patients with ALL from commencement of induction until completion of consolidation chemotherapy was undertaken from January 2008 to June 2013 in four hospitals in Melbourne, Australia. IFD was classified according to the revised European Organisation for Research and Treatment of Cancer criteria. Cost analysis was performed from an Australian public hospital perspective. RESULTS: Ninety-eight patients were included in the audit; 83 (85%) received PAP. Most patients (49/83, 59%) switched between two different antifungal agents, predominantly between liposomal amphotericin B and an azole. Five proven/probable and six possible IFD cases were identified. Proven/probable IFD was most common in patients receiving the BFM95 chemotherapy protocol. The incidence of proven/probable IFD was significantly lower in patients receiving PAP compared with those who did not (2/78, 2.6% versus 3/14, 21.4%; P = 0.024). For every five patients receiving PAP, one proven/probable IFD case would be prevented. Proven/probable IFD was associated with an additional median cost of 121,520 Australian dollars (95% CI: 90,781-180,141 Australian dollars; P < 0.001) compared with patients without IFD. CONCLUSIONS: This is the first multicentre study evaluating PAP use in patients with ALL. With the caveats of interpretation of retrospective, non-randomized data, PAP was associated with a reduced IFD risk.
Authors: Oliver A Cornely; Thibaut Leguay; Johan Maertens; Maria J G T Vehreschild; Achilles Anagnostopoulos; Carlo Castagnola; Luisa Verga; Christina Rieger; Mustafa Kondakci; Georg Härter; Rafael F Duarte; Bernardino Allione; Catherine Cordonnier; Claus Peter Heussel; C Orla Morrissey; Samir G Agrawal; J Peter Donnelly; Mark Bresnik; Michael J Hawkins; Will Garner; Nicola Gökbuget Journal: J Antimicrob Chemother Date: 2017-08-01 Impact factor: 5.790