Antifungal prophylaxis associated with decreased induction mortality rates and resources utilized in children with new-onset acute myeloid leukemia.

TitleAntifungal prophylaxis associated with decreased induction mortality rates and resources utilized in children with new-onset acute myeloid leukemia.
Publication TypeJournal Article
Year of Publication2014
AuthorsFisher BT, Kavcic M, Li Y, Seif AE, Bagatell R, Huang YS, Zaoutis TE, Torp K, Leckerman KH, Aplenc R
JournalClin Infect Dis
Volume58
Issue4
Pagination502-8
Date Published02/2014
ISSN1537-6591
KeywordsAdolescent, Antifungal Agents, Antineoplastic Agents, Chemoprevention, Child, Child, Preschool, Cohort Studies, Female, Humans, Immunocompromised Host, Infant, Infant, Newborn, Leukemia, Myeloid, Acute, Male, Mycoses, Retrospective Studies, Survival Analysis, Treatment Outcome
Abstract

BACKGROUND: Invasive fungal infections cause significant morbidity and mortality for children with acute myeloid leukemia (AML). Data on the comparative effectiveness of antifungal prophylaxis in this population are limited.

METHODS: A pediatric AML cohort was assembled from the Pediatric Health Information System database using ICD-9 codes and pharmacy data. Antifungal prophylaxis status was determined by pharmaceutical data review within 21 days of starting induction chemotherapy. Patients were followed until end of induction, death, or loss to follow-up. Cox regression analyses compared induction mortality and resources utilized between patients receiving and not receiving antifungal prophylaxis. A propensity score accounted for variation in demographic factors, location of care, and severity of illness at presentation.

RESULTS: Eight hundred seventy-one AML patients were identified; the induction case fatality rate was 3.7%. In the adjusted Cox regression model, patients receiving antifungal prophylaxis (57%) had a decreased hazard for induction mortality (hazard ratio [HR], 0.42; 95% confidence interval [CI], .19-.90). Children receiving prophylaxis were less frequently exposed to broad-spectrum gram-positive (incidence rate ratio [IRR], 0.87; 95% CI, .79-.97) and antipseudomonal β-lactam agents (HR, 0.91; 95% CI, .85-.96), had fewer blood cultures (IRR, 0.78; 95% CI, .71-.86), and had fewer chest CT scans (IRR, 0.73; 95% CI, .60-.88).

CONCLUSIONS: Antifungal prophylaxis in pediatric AML patients was associated with reduced induction mortality rates and supportive care resources. Further investigation is necessary to determine whether antifungal prophylaxis should include antimold activity.

DOI10.1093/cid/cit781
Alternate JournalClin. Infect. Dis.
PubMed ID24270167
PubMed Central IDPMC3905759
Grant ListP30 CA016520 / CA / NCI NIH HHS / United States
R01 CA133881 / CA / NCI NIH HHS / United States
R01 CA165277 / CA / NCI NIH HHS / United States
R01CA133881 / CA / NCI NIH HHS / United States