414. Voriconazole Prophylaxis and Mortality in Patients with Acute Myelogenous Leukemia
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Infectious diseases (ID) including invasive fungal infections (IFI) are an important cause of morbidity and mortality in acute myelogenous leukemia (AML) patients. A protocol of voriconazole prophylaxis and biweekly chest computed tomography (CT) scans was implemented beginning in 2006 at Moffitt Cancer Center (MCC), a large NCI-designated comprehensive cancer institute.
Methods: A retrospective review of MCC’s patient database showed 276 AML patients who died between 2000-2006. Patients were aggregated by calendar year of death and mean survival times. Additionally, charts for expired patients between 2005-2006 (n=80) were reviewed to determine the contribution of infections to mortality based on whether a) ID was a contributing cause of death on the death record (n=32), b) presence of active cultures, or c) ID was in the differential diagnosis for the cause of death.
Results: For the 276 AML patients studied at MCC, the mean survival rate during the study period was 13.5 months (95% CI=11.4-15.6) and increased significantly between 2000-2006 (R2=0.70, P=0.02). The mean survival for year 2006 was 23 months (n=28), significantly greater than that for 2005 (13 months, n=52, t=2.3, P=0.023). IDs contributed to mortality in the majority of patients with AML (24/32=0.75; 95% CI=70.2-79.8). Pneumonia was present in 56% (18/32) of patients and was predominantly fungal (14/18=78%). Positive blood cultures including bacteremia, fungemia and CMV viremia were found in 37% (12/32) of patients. IFI was diagnosed in 44% (14/32) of patients.
Conclusion: Infectious diseases, notably IFI, significantly contribute to the mortality of AML patients. Voriconazole prophylaxis against fungal infections combined with biweekly chest CT examination in high-risk patients with AML was associated with improved survival at a large cancer center.
Sally Alrabaa, MD1, David Atrubin, MPH2, M. Caire, BS1, John Greene, MD3, Richard Oehler, MD1, Tran Phung, MD1, Albert Vincent, PhD3, Gene Wetzstein, PharmD4 and  T. C. Phung, None..
S. Alrabaa, None..
R. L. Oehler, None..
M. T. Caire, None..
A. L. Vincent, None..
D. Atrubin, None..
G. Wetzstein, None..
J. N. Greene, None., (1)University of South Florida, Tampa, FL, (2)Hillsborough County Health Department, Tampa, FL, (3)H. Lee Moffitt Cancer Center, Tampa, FL, (4)Moffitt Cancer Center, Tampa, FL