2385. Comparison of Posaconazole and Voriconazole Prophylaxis Following Induction Chemotherapy for Acute Myeloid Leukemia
Session: Poster Abstract Session: Transplantation - Prophylaxis and Prediction
Saturday, October 7, 2017
Room: Poster Hall CD
Posters
  • Vori vs Posa ID Week 2017 poster Final.pdf (168.4 kB)
  • Background: Acute myeloid leukemia (AML) is associated with a high incidence of invasive fungal infection (IFI). Both posaconazole and voriconazole have shown superiority in preventing IFI compared to fluconazole. However, limited data exists comparing posaconazole and voriconazole following AML induction.

    Methods: This single center retrospective cohort included all AML patients receiving induction chemotherapy at West Penn Hospital from 9/1/2013 – 4/30/2017 who received antifungal prophylaxis with either posaconazole delayed release (DR) or voriconazole. The primary composite outcome was incidence of proven, probable, or possible IFI or initiation of an alternative antifungal for treatment of suspected or proven IFI. Secondary outcomes include the duration of inpatient length of stay (LOS), all cause 100 day mortality, duration of neutropenia, and incidence of re-induction.

    Results: The median duration of posaconazole and voriconazole was 18 and 20 days, respectively. There was no significant difference in the primary composite outcome between patients who received posaconazole or voriconazole (17% vs 13%; p=0.73). Baseline demographics and outcomes can be seen in Table 1.

    Table 1: Baseline characteristics and outcomes

     

    Posaconazole DR (n=36)

    Voriconazole (n=24)

    P value

    Age, years (IQR)

    61 (50-66)

    58 (48-67)

    0.86

    Neutropenic prior to induction, n (%)

    17 (47%)

    14 (58%)

    0.80

    Underwent re-induction, n (%)

    9 (25%)

    7 (29%)

    0.77

    Duration of neutropenia post induction, days (IQR)*

    26 (23-34)

    26 (24-33)

    0.73

    BAL performed, n (%)

    7 (19%)

    3 (12.5%)

    0.73

    CT chest performed, n (%)

    24 (67%)

    15 (63%)

    0.79

    Outcomes

    Composite primary outcome, n (%)

    6 (17%)

    3 (13%)

    0.73

    Proven IFI, n (%)

    0

    0

    1.00

    Probable IFI, n (%)

    1 (3%)

    1 (4%)

    1.00

    Possible IFI, n (%)

    3 (8%)

    1 (4%)

    0.64

    100 day mortality, n (%)

    4 (11%)

    5 (21%)

    0.46

    Inpatient LOS, days (IQR)

    30 (26-39)

    32 (29-42)

    0.24

    Outcomes are presented as medians; IQR=interquartile range

    *Patients in the posaconazole (n=6) and voriconazole (n=5) groups never achieved resolution of neutropenia and were excluded from this analysis.

    Conclusion: There were no differences in rates of IFI or other outcomes analyzed in our assessment of prophylactic posaconazole DR or voriconazole following AML induction chemotherapy.

    Derek Bremmer, PharmD, BCPS, Monank Patel, PharmD, BCPS, BCOP, Matthew Moffa, DO and Thomas Walsh, MD, Allegheny Health Network, Pittsburgh, PA

    Disclosures:

    D. Bremmer, None

    M. Patel, None

    M. Moffa, None

    T. Walsh, None

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