1444. Antifungal Prophylaxis Associated with Decreased Induction Mortality Rates in Children with New Onset Acute Myeloid Leukemia
Session: Poster Abstract Session: Fungal Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDSA_AML_Antifungal_abstract.pdf (177.3 kB)
  • Background:

    While studies in adults demonstrate benefit of antifungal prophylaxis in patients with prolonged neutropenia, the effectiveness in children is less well documented. We investigated the impact of antifungal prophylaxis on induction mortality and on supportive care resources in children with de novo acute myeloid leukemia (AML).

    Methods:

    This pediatric AML cohort was retrospectively assembled from the Pediatric Health Information System database. Patients were identified by ICD-9 codes for myeloid or unspecified leukemia and billing data for AML induction chemotherapy. Exposure to antifungal prophylaxis was determined by manual review of pharmaceutical billing data in the first 21 days of induction. Patients were censored at death, loss to follow-up, or the first day of the third chemotherapy course. Induction mortality was compared between patients receiving antifungal prophylaxis versus those not receiving prophylaxis using Cox regression analysis. The rates of antibacterial exposures, CBCs, blood cultures and chest CT scans were compared between the two groups using Poisson regression models. A propensity score was included to account for variation in age, gender, race, insurance status, hospital site and severity of illness at time of presentation.

    Results:

    931 new onset AML patients from 38 children’s hospitals were identified with an overall induction case fatality rate of 3.8%.  In the propensity score adjusted model, patients receiving antifungal prophylaxis (532, 57%) had a significantly decreased hazard for induction mortality (HR: 0.41, 95% CI: 0.20- 0.85).  Children receiving prophylaxis were less frequently exposed to broad-spectrum Gram-positive antibiotics (IRR: 0.87, 95% CI: 0.79-0.96), had fewer blood cultures (IRR: 0.77, 95% CI: 0.70-0.86) and had reduced frequency of chest CT scans (IRR: 0.70, 95% CI: 0.59-0.84).

    Conclusion:

    Antifungal prophylaxis is associated with reduced AML induction mortality and reduced supportive care resources utilization.  Some of this benefit may be related to concomitant antibacterial prophylaxis, which was not measured in this cohort.  Antifungal prophylaxis should be considered for children with AML.

    Brian Fisher, DO, MPH, MSCE1, Marko Kavcic, MD1, Yimei Li, PhD1, Alix Seif, MD, MPH1, Rochelle Bagatell, MD1, Yuan-Shung Huang, MS1, Theoklis Zaoutis, MD, MSCE2, Kari Torp1, Kateri Leckerman, MS1 and Richard Aplenc, MD, PhD1, (1)The Children's Hospital of Philadelphia, Philadelphia, PA, (2)Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, The Children's Hospital of Philadelphia, Philadelphia, PA

    Disclosures:

    B. Fisher, None

    M. Kavcic, None

    Y. Li, None

    A. Seif, None

    R. Bagatell, None

    Y. S. Huang, None

    T. Zaoutis, None

    K. Torp, None

    K. Leckerman, None

    R. Aplenc, None

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