AI Article Synopsis
- A study investigated antifungal treatment (AFT) duration and adjustments in 71 immunocompromised patients with invasive mold infections (IMIs) linked to acute myelogenous leukemia at three hospitals from 2010-2022.
- The findings revealed a median AFT duration of 227 days, with extensive treatment changes often driven by clinical efficacy or toxicity issues; almost 80% of patients experienced at least two adjustments.
- The study concluded that AFT duration often exceeds guidelines, highlighting the need for more data and improved recommendations tailored to the level of immunosuppression in patients.
Article Abstract
Background: Limited data exist on when and how to stop antifungal treatment (AFT) in patients with invasive mold infections (IMIs) who are immunocompromised.
Methods: This retrospective multicenter study included adult patients with acute myelogenous leukemia and proven/probable IMI (1 January 2010-31 December 2022) in 3 university hospitals. The primary objective was to describe AFT duration and adaptation. Secondary objectives were to investigate the reasons for AFT adjustments and prolongation.
Results: In total 71 patients with 73 IMIs were identified; 51 (71.8%) had an allogeneic hematopoietic cell transplant. Most infections were invasive aspergillosis (IA; 49/71, 69%), followed by mucormycosis (12, 16.9%) and other (12, 16.9%); there were 2 mixed infections. Median treatment duration was 227 days (IQR, 115.5-348.5). There was no difference in AFT duration between patients with IA and non-IA IMI ( = .85) or by center ( = .92). Treatment was longer in patients with an allogeneic hematopoietic cell transplant vs not ( = .004). Sixteen patients (22.5%) had no therapy modifications. In 55 patients (77.5%), a median 2 changes (IQR, 1-3; range, 1-8) were observed. There were 182 reasons leading to 165 changes, associated with clinical efficacy (82/182, 44.5%), toxicity (47, 25.8%), and logistical reasons (22, 12.1%); no reason was documented in 32 changes (18.8%). AFT was continued beyond days 90 and 180 in 59 (83%) and 39 (54.9%) patients, respectively, mostly due to persistence of immunosuppression.
Conclusions: AFT in patients with acute myelogenous leukemia and IMI is longer than that recommended by guidelines and is frequently associated with treatment adjustments due to variable reasons. More data and better guidance are required to optimize AFT duration and secondary prophylaxis administration according to immunosuppression.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11097115 | PMC |
| http://dx.doi.org/10.1093/ofid/ofae201 | DOI Listing |
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